Case Studies in Ophthalmology
Cases for the Ophthalmology Clerkship
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Case #46 Unequal Pupils
History
This 8 year old girl was noted to have a left dilated and fixed pupil 4 months ago. There is no diplopia.
Her complaints all seem to be related to the difference in retinal illumination between the two eyes.
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Question #1
Which is the abnormal eye?
Question #2
How do you know it isn’t the right pupil that is abnormally small?
Question #3
What are some of the things that can cause a pupil to be large and fail to react to light?
Start at the periphery with the iris itself:
Question #4
How do you explain the response of the pupils seen in the following photograph which was taken about 30 minutes after 0.1% pilocarpine was instilled in the conjunctival cul de sac of each eye?
References
Thompson HS: The pupil. In Adler’s Physiology of the Eye. 8th edition. R. Moses and W. Hart. St Louis. CV Mosby 1987.