Blindingly obvious--Combivent as a cause of a unilateral painless mydriasis.

Case Report A 31 year female presented to the emergency department with rapid onset of blurring of vision, dizziness, and nausea. Examination showed a painless, fixed, dilated left pupil. Neurological examination was otherwise normal. There was no history of headache or trauma. MRI brain was reported as normal. Full blood count, electrolytes, serum glucose, and inflammatory markers were also normal. Topical pilocarpine 1% induced normal constriction of the right pupil but had no effect on the left, confirming the pharmacological basis of the left mydriasis 1 . A detailed history revealed that the above symptoms developed shortly after preparing a combiventfi nebuliser for her mother. Following the instillation of Combiventfi to the nebuliser acorn, she rubbed her left eye. A diagnosis of a pharmacologically dilated left pupil, as a result of topical Combiventfi was made. The combined anti-muscarinic effect of ipratropium bromide and sympathomimetic effect of salbutamol both served to cause mydriasis. On review 1 week later, the patient’s vision had returned to normal and examination was normal.