#Blown pupil causes full

Tonic pupil, as seen with our patient, is a common cause of isolated pupil dilation. 1 In these rare cases of third nerve palsies presenting initially with only pupillary involvement, a review of the literature found that these patients also either presented with headache, seizure or other neurological deficits, or the extraocular motility deficits developed early in the course of their illness. Although in theory a compressive lesion of the third nerve may cause an isolated dilated pupil without any extraocular motility deficit or eyelid ptosis, in practice this rarely occurs.

Clinicians fear there is a serious underlying etiology when the majority of causes for acute isolated dilation are benign these include tonic pupil, pharmacologic dilation and transient pupillary mydriasis.īy far the biggest fear of a patient presenting with a dilated pupil is a third nerve palsy. Often, patients who present with an acute isolated dilated pupil are put through extensive and unnecessary testing and referrals. The pupils of both eyes in bright light measuring 3mm and 4.5mm in the right and left eyes, respectively. He was very minimally bothered by the light sensitivity and wears sunglasses when needed.įig. The MRI and MRA were subsequently cancelled. Our patient was otherwise in good general health and no further workup was necessary. We discussed the tonic pupil with our patient as well as informing his physician. We instilled 0.125% pilocarpine in the left eye, which, after 30 minutes, constricted the pupil to 3mm, confirming the diagnosis (Figure 2). The history and clinical findings were most consistent with a tonic pupil. No disc edema, disc pallor, artery or vein occlusions existed and the retina was flat and attached. However, the left eye showed a generalized sluggish constriction as well as sectoral iris paralysis temporally (Figure 1). When examining the pupils under the slit lamp, the right pupil showed an even and normal constriction and dilation when turning the slit beam on and off. Anterior segment exam was remarkable for 2+ nuclear sclerosis. No third, fourth or sixth nerve palsy or other neurologic deficit was noted.

#Blown pupil causes full

Extraocular muscles were full and smooth. Reverse flashlight testing revealed no afferent pupil defect. Pupils measured 3mm OD and 4.5mm OS in bright light and 7.5mm OD and 7.5mm OS in dark light. The patient’s best-corrected visual acuities were 20/25 in each eye. He denied ever using any motion sickness patches or over-the-counter eye drops. His medical history was remarkable for hypothyroidism and high cholesterol and was taking levothyroxine and atorvastatin. He denied any other neurologic issues or symptoms. The patient himself was unaware of this change however, upon questioning he noticed increased light sensitivity out of the left eye for at least three months. In addition to a referral to our clinic, his internist scheduled him to have an intracranial magnetic resonance imaging (MRI) and angiography (MRA). D uring a medical exam, an internal medicine doctor noted a difference in pupil size-left pupil larger than right-in a 62-year-old Caucasian male, which was never noted on prior visits.