Some additional info regarding the patients history and physical:
- Acute onset. Driver's license does not demonstrate that this is a chronic physiologic anisocoria.
- Anisocoria is greater in light than dark. Abnormal pupil is the larger one.
- There is no ptosis or extraocular muscle palsies. Third nerve palsy is unlikely.
- No recent eye trauma. Iris appears intact on slit-lamp examination. Iris sphincter muscle damage is unlikely.
- Denies getting any mydriatic substance in the eye ie atropine, scopolamine patch, ipratropium bromide, pseudoephedrine. Unlikely pharmacologically induced.
*
*
*
*
*
*
*
*
*
*
Abnormal pupil had no reaction to light but a slow constriction to prolonged near stimulation (looking at thumb), a light-near dissociation. Diagnosis: Adie's tonic pupil. To learn more about this entity, click here.
Source
Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease
Practical Neurology DVD Review
Image source: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJqnAA4APhM7xTgXm6h5i6QJ0H-RABpqH3LQn8UYQEu197ouNyvg33oHQhFUonpvKuuT9lJRHJoi73sKEQsOl-gf5OLGX_XNzK-DzX0CfdV781GrmjryQFFhp3LF96DCYNkSS8g_sLH1Ml/s400/Anisocoria.jpg