Anisocoria From Jimsonweed

To the Editor.— The original article by Price¹and the recent exchange of letters inJAMAconcerning anisocoria from scopolamine patches emphasize an interesting addition to the differential diagnosis of a fixed and dilated pupil. We report a similar case in which we identified an isolated peripheral anticholinergic effect from local contact with jimsonweed. The jimsonweed plant,Datura stramonium, grows wild throughout the United States, and ingestion of any part of the plant produces a characteristic syndrome of systemic anticholinergic poisoning.² Report of a Case.— A 38-year-old man presented to the emergency department complaining of blurred vision and a dilated pupil. He had spent the morning trimming weeds with a mechanical weed trimmer. He felt otherwise normal and specifically denied headache, nausea, or a stiff neck. His mental status was normal. The right pupil was fully dilated at 6 mm and nonreactive to light, while the left pupil was