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Systemic toxicity in a child after topical cyclopentolate eye drops application

An 8-year-old girl was seen in our ophthalmology OPD who had come with complaints of mild pain in both eyes for 1 month. Her unaided vision in both eyes was 6/6. Her weight was 20 kg. Cyclopentolate 1% eye drops was administered twice to the child at 5 min interval in both eyes. The child became restless after 30 min of installation of eye drops installation. She started behaving abnormally and was not allowing to do retinoscopic examination. She had altered behavior, visual hallucination, and difficulty in walking. She was disoriented with slurred speech. She had ataxia and frequent tightening of limbs with jerky movements and was plucking her hair. Her pulse rate was 90/min and blood pressure was 120/90 mm of Hg. Her oxygen saturation was 94% in room air. The child was shifted to nearby hospital where a paediatrician and anesthesiologist were available and was kept under observation. Child’s pulse, blood pressure, and oxygen saturation were monitored for the next 5 hours. The child recovered completely over the next 8 hours.