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To the Editor.
—I read with interest Wahl's report of a systemic reaction to tropicamide (Arch Ophthal82:320-321, 1969). However, the description of the episode leads one to suspect that it was not an anaphylactic reaction, as stated by Wahl.Anxiety and bronchospasm, with pruritis, sneezing, coughing, and wheezing, are prominent manifestations of anaphylaxis, but are not described in this case. Cyanosis, loss of consciousness, and seizures occur late, when bronchoconstriction is sufficiently intense to produce hypoxemia and cerebral hypoxia. Without aggressive therapy the condition worsens, vascular tone is lost, shock ensues, and death can occur.By contrast, the initial manifestation in the present case was loss of consciousness, which was followed by generalized muscular rigidity, opisthotonos, pallor, and finally cyanosis. Recovery was rapid and spontaneous, with generalized weakness and drowsiness which resolved over the course of several hours. This is the description of a grand mal seizure, not
Rogell GD. SYSTEMIC REACTION TO TROPICAMIDE. Arch Ophthalmol. 1970;83(3):382-383. doi:10.1001/archopht.1970.00990030382020