A young woman has recurrent episodes of unilateral mydriasis lasting several minutes. The left pupil becomes large and deformed, described as “egg-shaped” (figure). Examination, including pharmacologic pupil tests, revealed no ophthalmologic or neurologic abnormalities. Cranio-orbital MRI was normal. Diagnosis of tadpole pupil was confirmed by self-taken photographs using a cellular phone.
(Top) On examination, the pupils are round, isocoric, and reactive to light. (Bottom) On this self-taken photograph, the left pupil is no longer round and is larger than the right pupil. Focal dilation of the superonasal sector of the left pupil is readily visible.
Spontaneous segmental spasm of the iris dilator can cause pupillary distortion that resembles the shape of a tadpole.1,2 Occasional patients with tadpole pupil have underlying Horner syndrome; otherwise, the syndrome is benign and self-limited.1 Cellular phone “telemedecine” was particularly helpful in diagnosing this form of episodic mydriasis.
Footnotes
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A. Kawasaki has received honoraria from serving on a scientific advisory panel for Bayer SpA. C. Mayer reports no disclosures. Go to Neurology.org for full disclosures.
- Copyright © 2012 by AAN Enterprises, Inc.
Letters: Rapid online correspondence
- Reply to Dr. Friedman
- Episodic Tadpole Pupil - Possibly a Migraine Variant?
- Tadpole pupil
- Response to comment by Dr. Egan
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