Case of a fixed and dilated pupil: acute anisocoria secondary to aerosol ipratropium bromide

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, …