Although he followed up application with thorough handwashing, he engaged in strenuous household work, which may have contributed to incidental spread of the medication to his eye. Upon detailed review of medications and the patient’s activity on the day of presentation, it is most likely that the mydriatic pupil was a side effect of the glycopyrronium 2.4% cloth he used on his face approximately 2.5 hours prior to noticing blurry vision. Patient had normal range of motion, tone, sensation, and strength in the upper and lower extremities with no rashes, lesions, swelling, or erythema noted. Respiratory effort was normal with no apparent wheezing or shortness of breath. Upon further inspection of the left eye, the globe was intact and the conjunctiva were not injected, and no hyphema was noted. The left pupil was enlarged and unreactive to light ( Figure 1). The patient was alert, oriented, interactive and well-appearing. On physical exam, he was hypertensive with a blood pressure of 185/105, but in no apparent distress. Integumentary: denies rashes, pigmentation, and dryness.Psychiatric: denies depression, agitation, and anxiety.Genitourinary: denies hematuria, dysuria, and incontinence.Musculoskeletal: denies myalgias, joint pain, and joint stiffness.Pulmonary: denies shortness of breath, cough, and wheezing.Cardiovascular: denies chest pain, palpitations, and edema.
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