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Case Report: Anisocoria (Unilateral Acute Mydriasis) After Travel on a Cruise Ship

A 32-year-old female presented to the Emergency Department (ED) with a complaint of blurred vision of a three hour duration. Her husband noted that her right pupil appeared to be dilated. However, on repeat questioning, the patient offered that she had just returned from a Caribbean cruise. She was asked about the use of a scopolamine patch. At that point, she recalled that she had removed a scopolamine patch from behind her right ear and had removed her contact lses just prior to the onset of symptoms. She noted that she had experienced some difficulty removing the contact lens of her right eye. She had removed the contact lens and the scopolamine patch with the right hand. The blurry vision began minutes later. The patient was offered confirmatory testing with pilocarpine drops, but she declined, as she felt very confident in the association of the association of the scopolamine patch with the onset of symptoms. She was discharged with follow up with ophthalmology. Her symptoms resolved fully within 24 hours of ED discharge. This case highlights the importance of recursive history taking in the event of an usual presentation.