Ocular Anticholinergic Toxicity from Datura arborea: A Reversible Mimic of Third Nerve Palsy

Authors : Gülçim Kocairi, Yalcin Golcuk, Tayyibe Büşra Türkmen

Pages : 102-104

Doi:10.33706/jemcr.1698743

View : 41 | Download : 44

Publication Date : 2025-09-30

Article Type : Other Papers

Abstract :Introduction Unilateral fixed mydriasis is frequently associated with neurologic emergencies such as third cranial nerve palsy. However, rare toxicologic mimics—particularly those caused by topical exposure to anticholinergic alkaloids—may present similarly and lead to unnecessary neuroimaging. Datura arborea, an ornamental plant of the Solanaceae family, contains potent tropane alkaloids capable of inducing transient pharmacologic mydriasis via muscarinic receptor blockade. Case Report A 42-year-old previously healthy male developed sudden-onset blurred near vision and photophobia in the left eye shortly after accidental ocular contact with a flowering plant branch. Examination revealed left-sided dilated, nonreactive pupil with preserved extraocular movements, intact lid position, and impaired accommodation. Neurologic and fundoscopic examinations were unremarkable. A retrieved plant specimen was identified as Datura arborea by a consulting botanist. Pharmacologic testing with 1% pilocarpine produced no miosis, confirming muscarinic antagonism. The patient was managed conservatively with ocular irrigation, lubrication, and photoprotection. Symptoms resolved completely within 48 hours without recurrence. Conclusion Topical exposure to Datura arborea can produce unilateral pharmacologic mydriasis that closely mimics third nerve palsy. Early recognition, targeted exposure history, and bedside pupillary testing can guide appropriate management and help avoid unnecessary neurologic evaluation.
Keywords : datura arborea, antikolinerjik, anizokori

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