The patient did spring board diving regularly as part of her athletic training and denied any significant trauma to her eyes or face outside of her normal regimen. She had participated in spring board diving competition the day prior to presentation, with associated repeated water impaction from three-meter height. Subjectively, associated symptoms included blurry vision in both eyes with worse far vision in the right eye. The patient initially denied touching anything unusual prior to touching her eyes. She denied wearing contacts or placing eye drops in either eye. She rated the headache pain as 7/10 with exposure to bright light and 0/10 when in a dark room neither eye was painful.

The case presentation was submitted to the Hawai‘i Pacific Health Research Institute for review and was deemed not needing institutional review board approval, study number 2019-003.Ī 14-year-old girl with a non-contributory past medical history presented to the pediatric emergency department with chief complaint of “right pupil very dilated and not changing with light changes.” She woke up that morning in her usual state of health, went outside to film a video for a school project, and 30 minutes later developed right eye photophobia and right unilateral temporal headache with exposure to bright light. 6 In this case report, we examine the case of a 14-year-old female who presented to the pediatric emergency department with acute anisocoria and unilateral mydriasis after contacting an Angel's trumpet plant and who had complete resolution of symptoms four days following eye contamination. 5 Also, only one case report of acute anticholinergic toxicity related to Angel's trumpet tea ingestion has been published from Hawai‘i.

4 Despite the high number of plants cultivated, between 20 only eleven events of human exposure to members of these genera were reported to the Hawai‘i Poison Center, out of the total 44 anticholinergic plant exposures that were reported. Brusmansia x candida, one of the many Brugmansia plants commonly referred to Angel's trumpet,is the most commonly cultivated species within this genus. 3 There continues to be confusion regarding what genus member plants belong to therefore, case reports and poison control reports of contamination and ingestion interchange the genera. Lockwood separated the genus Datura into two sub-genera: Datura and Brusmansia. 2 The Datura and Brusmansia genera of plants are often used interchangeably due to all member plants initially being included in the genus Datura. The first Angel's trumpet plant, at that time listed as Datura arborea, was brought to Hawai‘i in 1825, aboard the HMS Blonde. Although eye contamination with the Angel's trumpet plant is self-limited and resolves within a week, the appearance of a persistently unilateral mydriatic eye can be alarming to patients and clinicians, which too often results in an unnecessary, costly workup. It is critical when obtaining a history from a patient with such a presentation to ask explicitly about any contact with plants prior to onset of symptoms. This likely explains why even brief contact with the plant can result in unintentional contamination of the eye and in mydriasis. The three active components occur in different parts of the plant, including on the small glandular hairs that cover the entire plant. The Angel's trumpet plant contains three active components which can result in mydriasis: hycosamine, atropine, and scopolamine. We report the case of a 14-year-old girl who presented to the pediatric emergency department with acute anisocoria and unilateral mydriasis after contacting an Angel's trumpet plant and who had complete resolution of symptoms four days following eye contamination. Acute anisocoria and unilateral mydriasis is physically alarming to patients and diagnostically worrisome to clinicians.

Anisocoria meaning