Systemic toxicity of topical cyclopentolate eyedrops in a child

An 8 year old girl was seen in our ophthalmology OPD who had come with complains of mild pain in both eyes since 1 month. Her unaided vision in both eyes was 6/6. Her weight was 20 kilogram. Cyclopentolate 1% was administered twice to the child at 5 minutes interval. Child became restless after 30 minutes of installation of eye drops; 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/minute and blood pressure was 120/90 mm of Hg. Her oxygen saturation was 94% in room air. Child was shifted to nearby hospital where a pediatrician and anesthesiologist were available and was kept under observation. Childs pulse, blood pressure and oxygen saturation were monitored for the next 5 hours. Child recovered completely over the next 8 hours.