Editors’ Note: Dr. Egan inquires about the possibility of Tournay phenomenon in Kawasaki and Mayer's “Tadpole pupil.” Dr. Charles, in reference to “Disease-modifying drugs for multiple sclerosis in pregnancy: A systematic review,” suggests that it might be appropriate to continue glatiramer acetate in women trying to conceive given the lack of evidence of fetal risk. Authors Tremlett et al. advise that, at this point, each case should continue to be assessed individually. Megan Alcauskas, MD, and Robert C. Griggs, MD
Drs. Kawasaki and Mayer1 present a nice example of a teardrop-shaped or tadpole pupil in the left eye of their subject. However, I would like the authors to address one other finding in the figure. Observing the small right pupil in the adducted eye, did the authors consider whether any Tournay phenomenon2 was present and whether this would change their etiologic diagnosis? The photograph taken by the patient clearly shows that she is holding her eyes in a leftward direction, which might induce the anisocoria.
Author Response
Tournay phenomenon is a gaze-evoked anisocoria and is one cause of episodic mydriasis. While the figure happens to show the patient's eyes in lateral gaze, the episodes of pupillary dilation do occur spontaneously when the eyes are in the primary position (i.e., when the patient views her eyes directly in the mirror). Also, Tournay phenomenon does not typically cause such distortion of pupillary shape. For these 2 reasons, we believe the patient's episodes of spontaneous, non-gaze-evoked mydriasis with distortion is best described as tadpole pupil phenomenon.
- © 2013 American Academy of Neurology
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