Atlas of Ophthalmology

Pharmacologic Mydriasis (Anisocoria)

Pharmacologic Mydriasis (Anisocoria)
When anisocoria is greater in bright light the abnornal pupil is the larger pupil. One should first evaluate the iris anatomy to check for sectoral iris palsy or trauma. If diagnosis is still not made, instill 0.1% pilocarpine, if it does not constrict, it is not Adie's Pupil. Next, we suspect pharmacologic mydriasis, and to comfirm diagnosis a drop of pilocarpine 1% will not constrict the dilated pupil. If the pupil is constricted with 1% Pilocarpine a third nerve palsy is suspected. In the case below, we present pharmacologic mydriasis Top Photo: Before application of phenylephrine 2.5% and tropicamide 1% in right eye. Pupils are equal in size under normal light conditions. Extraocular movements and lid function were normal. Ishihara, visual fields, Optical coherence tomography of optic nerve and macula, were normal. Vision near and distance 20/20 OU. Middle Photo: Before application of phenylephrine 2.5% and tropicamide 1%. Both pupils constrict normal to light when the flashlight is applied to the right eye in this photo. Bottom Photo: After application of phenylephrine 2.5% and tropicamide 1%, the right pupil remains fixed and dilated in all lighting situations. In this photo, the flashlight is being applied to the right eye to show the intact light reflex. Detection of an afferent pupillary defect requires only one working pupil. In this case, an intact light reflex is present because the contralateral eye (left) constricts even if the pupil is abnormal (right eye). In this case, no afferent pupillary defect (Marcus Gunn Pupil) is present in right eye because left pupil constricts when light is applied to right pupil. phenylephrine 2.5% and tropicamide 1% are used to dillate pupils for eye exams and intraocular surgery because together their dilating effects last 2-8 hours. Other mydriatics such as homatropine and atropine dilate the eye for days and are useful for cycloplegic refractions and treating intraocular inflammation. Atropine ointments are used in infants because drops can be absorbed systemically more easilly and cause systemic side effects.
Luviano, Damien, M.D., SETMA¦1, Beaumont, USA
H57.0
Neuro-Ophthalmology -> Pupillary Abnormalities -> Neurogenic Disorders -> Pharmacologic Mydriasis
Pseudo Horner syndrome, contralateral miosis, physiologic, cocaine, dilator, hydroxyamphetamine, coma, swinging flashlight, iris,
8003
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