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
Disputes & Debates: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.