Abstract
The dilated pupil can present a significant challenge to the clinician. Although in most cases a complete history and physical examination is sufficient to make an accurate diagnosis, selected patients will require further investigation, including pharmacologic testing and neuroimaging. This review outlines the physiology, clinical features, and diagnostic approach to the most important causes of the dilated pupil. Particular attention is given to recent publications on this topic.
Similar content being viewed by others
References and Recommended Reading
Martin TJ, Corbett JJ: The pupil. In Neuro-ophthalmology: The Requisites in Ophthalmology. Edited by Martin TJ and Corbett JJ. St. Louis: Mosby; 2000:191–209.
Lam BL, Thompson HS, Corbett JJ: The prevalence of simple anisocoria. Am J Ophthalmol 1987, 104:69–73.
Pryse-Phillips W: Companion to Clinical Neurology, Second Edition. New York: Oxford University Press; 2003.
Kline LB, Bajandas FJ: Neuro-Ophthalmology Review Manual, Fifth Edition. Thorofare, NJ: Slack; 2004.
Jacobson DM: Relative pupil-sparing third nerve palsy: Etiology and clinical variables predictive of a mass. Neurology 2001, 56:797–798.
Jacobson DM: Pupil involvement in patients with diabetesassociated oculomotor nerve palsy. Arch Ophthalmol 1998, 116:723–727.
Kupersmith MJ, Heller G, Cox TA: Magnetic resonance angiography and clinical evaluation of third nerve palsies and posterior communicating artery aneurysms. J Neurosurg 2006, 105:228–234.
Schultz KL, Lee AG: Diagnostic yield of the evaluation of isolated third nerve palsy in adults. Can J Ophthalmol 2007, 42:110–115.
Dimopoulos VG, Fountas KN, Feltes CH, et al.: Literature review regarding the methodology of assessing third nerve paresis associated with non-ruptured posterior communicating artery aneurysms. Neurosurg Rev 2005, 28:256–260.
Kardon RH, Corbett JJ, Thompson HS: Segmental denervation and reinnervation of the iris sphincter as shown by infrared videographic transillumination. Ophthalmology 1998, 105:313–321.
Albayram S, Ozer H, Sarici A, et al.: Unilateral mydriasis without ophthalmoplegia — a sign of neurovascular compression?: case report. Neurosurgery 2006, 58:582–584.
Martinelli P: Holmes-Adie syndrome. Lancet 2000, 356:1760–1761.
Ford PA, Barnes PJ, Usmani OS: Chronic cough and Holmes-Adie syndrome. Lancet 2007, 369:342.
Csak T, Folhoffer A, Horvath A, et al.: Holmes-Adie syndrome, autoimmune hepatitis and celiac disease: a case report. World J Gasteroenterol 2006, 12:1485–1487.
Morelli N, Gallerini S, Cafforio G, et al.: Adie tonic pupil associated to endometriosis. Neurol Sci 2006, 27:80–81.
Hagemann G, Bartke T: Adie’s pupil in the Ross syndrome. N Engl J Med 2006, 355:6.
Nolano M, Provitera V, Perretti A, et al.: Ross syndrome: a rare or a misknown disorder of thermoregulation? A skin innervation study on 12 subjects. Brain 2006, 129:2119–2131.
Bremner F, Smith S: Pupil findings in a consecutive series of 150 patients with generalized autonomic neuropathy. J Neurol Neurosurg Psychiatry 2006, 77:1163–1168.
Selhorst JB: The pupil and its disorders. Neurol Clin 1983, 1:859–881.
Izadi S, Choudhary A, Newman W: Mydriasis and accommodative failure from exposure to topical glycopyrrolate used in hyperhidrosis. J Neuro-Ophthalmol 2006, 26:232–233.
Raman SV, Jacob J: Mydriasis due to Datura inoxia. Emerg Med J 2005, 22:310–311.
Klintz P, Villain M, Barguil Y, et al.: J Anal Toxicol 2006, 30:454–457.
Iosson N: Nebulizer-associated anisocoria. N Engl J Med 2006, 354:9.
Brodie T, Adalat S: Unilateral fixed dilated pupil in a well child. Arch Child Dis 2006, 91:961.
Udy A: A 10-year-old child with status asthmaticus, hypercapnia and a unilateral dilated pupil. Pediatr Anesth 2005, 15:1120–1123.
Openshaw H: Unilateral mydriasis from ipatropium in transplant patients. Neurology 2006, 67:914.
Li G, Polomeno RC: Congenital mydriasis: spontaneous resolution in one of two cases. Can J Ophthalmol 2005, 40:204–207.
Chadha V, Tey A, Kearns P: Benign episodic unilateral mydriasis. Eye 2007, 21:118–119.
Harle DE, Wolffsohn JS, Evans BJW: The pupillary light reflex in migraine. Ophthal Physiol Opt 2005, 25:240–245
Thompson HS, Zackon DH, Czarnecki JS: Tadpole-shaped pupils cause by segmental spasm of the iris dilator muscle. Am J Ophthalmol 1983, 96:467–477.
Balaggan KS, Hugkulstone CE, Bremner FD: Episodic segmental iris dilator muscle spasm: the tadpole-shaped pupil. Arch Ophthalmol 2003, 121:744–745
Urrets-Zavalia A: Fixed, dilated pupil, iris atrophy and secondary glaucoma; a distinct clinical entity following penetrating keratoplasty in keratoconus. Am J Ophthalmol 1963, 56:257–265.
Jastaneiah S, Al-Towerki AE, Al-Assiri A: Fixed dilated pupil after penetrating keratoplasty for macular corneal dystrophy and keratoconus. Am J Ophthalmol 2005, 140:484–489.
Yuzbasioglu E, Helvacioglu F, Sencan S: Fixed, dilated pupil after phakic intraocular lens implantation. J Cataract Refract Surg 2006, 32:174–176.
Espana EM, Ioannidis A, Tello C, et al.: Urrets-Zavalia syndrome as a complication of argon laser peripheral iridoplasty. Br J Ophthalmol 2006, 91:427–429.
Young CC, Simons KB, Jacobs B: Traumatic mydriasis: “cat’s eye” in a football player. Clin J Sport Med 2006, 16:179–180.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Moeller, J.J., Maxner, C.E. The dilated pupil: An update. Curr Neurol Neurosci Rep 7, 417–422 (2007). https://doi.org/10.1007/s11910-007-0064-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11910-007-0064-9