Topical apraclonidine can cause severe lethargy in infants, researchers report

Using topical apraclonidine to diagnose Horner syndrome in infants can inadvertently cause severe lethargy lasting up to 10 hours, necessitating a hospital admission and the administration of oxygen, according to a report in the June issue of the Journal of the American Association for Pediatric Ophthalmology and Strabismus.

Patrick Watts, FRCOphth, and colleagues described five such cases that occurred in infants under 6 months of age who received 1% apraclonidine drops. All five children experienced adverse reactions, including extreme drowsiness or unresponsiveness.

Although no deaths or permanent injuries occurred, the authors recommended against using apraclonidine in infants. Additionally, if apraclonidine must be used, the infants should be observed for at least 2 hours after receiving the drug and should be admitted to a pediatric ward if they develop lethargy, bradycardia or a reduced respiratory rate, the authors said.