Unilateral fixed dilated pupil in a child with asthma

A 1-year-old boy was treated in our Paediatric Intensive Care Unit for an acute asthma exacerbation. Because he failed to respond to frequent nebulisation with salbutamol and ipratropium, he was mechanically ventilated. Shortly after intubation, a unilateral fixed dilated pupil was noticed. There were no signs of raised intracranial pressure, or any cerebral swelling or haemorrhage on the CT- scan of the brain. Therefore, local contamination of the eye with a mydriatic agent was assumed to be the most probable cause.