Topical phenylephrine-induced hypertensive crisis during pediatric neurosurgery: A case report

Phenylephrine (1–10%) eye drops are widely used for mydriasis during ophthalmic examination and surgery; however, they can cause serious systemic effects in children. We report a case of a 22-month-old male child who sustained a skull fracture and right middle cerebral artery dissection after a fall, and later developed infarction, meningoencephalocele, proptosis, and chemosis of the right eye. The child underwent meningoencephalocele excision, chemosis reduction, and tarsorrhaphy. During tarsorrhaphy, a hypertensive crisis occurred following the instillation of 5% phenylephrine and 0.8% tropicamide, likely due to systemic absorption through the highly vascular conjunctiva. This report describes the management of this complication and highlights precautions to minimize morbidity during combined neurosurgical and ophthalmological procedures.