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Case of a fixed and dilated pupil: acute anisocoria secondary to aerosol ipratropium bromide
  1. Laura Royce1,
  2. Chris Schulz2,
  3. Nick Brown3
  1. 1Department of General Paediatrics, Salisbury NHS Foundation Trust, Odstock Road, Salisbury, SP2 8BJ, UK
  2. 2Department of Ophthalmology, Salisbury NHS Foundation Trust, Salisbury, UK
  3. 3Department of Paediatrics, Salisbury District Hospital, Salisbury, UK
  1. Correspondence to Dr Laura Royce, Community Child Health, Solent NHS Trust- west, Adelaide Centre Level 2, Western Community Hospital Campus, William MacCloed Way, Millbrook, Southampton, SO16 4XE, UK; l_royce{at}

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A 2-year-old boy was presented with acute anisocoria (figure 1). He had a history of DiGeorge syndrome, with right-sided perisylvian polymicrogyria, left-sided hemiplegia and seizure disorder. He was a known asthmatic, for which he was on ipratropium bromide through a spacer. His left pupil was maximally dilated and unreactive. Right pupillary reactions were normal. Acuity was 6/12 bilaterally with full extraocular movements, …

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