Hyoscine skin patches diminish salivation by their
anticholinergic action. The aim of reporting this case series is to present the ophthalmic side effects in children, and to highlight the precautions to take. Five children (two males, three females; age range 8-18y) with quadraplegic
cerebral palsy (Gross Motor Function Classification System Level V) and profound intellectual impairment, wearing
hyoscine skin patches to control excessive salivation, were examined.
Binocular visual acuity, pupil reaction, pupil diameter, and dynamic retinoscopy were recorded before and after instilling guttae
cyclopentolate 1%. The accommodative responses were compared with the expected norms. Spectacle correction was provided for
refractive error and to compensate for lack of accommodation. Tinted
lenses were provided for
photophobia. Visual assessment was repeated 6 months later. All children had dilated pupils with a mean diameter of 7.8mm (range 7-9mm) before instilling guttae
cyclopentolate. Mean pupil constriction to bright light was only 1.8mm (range 1-2mm). Mean resting accommodation was 0.45 dioptres (D; range 0-1D) and no accommodative responses were detected on dynamic retinoscopy. Three children were photophobic. Visual behaviour was seen to improve after the use of appropriate
spectacles.
Photophobia was relieved by tinted
lenses. The
anticholinergic effects of
hyoscine skin patches can cause
photophobia and impair vision due to pupil dilatation and
paralysis of accommodation. Appropriate
spectacles are recommended.