1/20/2024 0 Comments Causes of fixed dilated pupil![]() In the differential diagnosis of pupil dilatation, occurrence of tears in the iris sphincter caused by blunt eye trauma should be considered. In the literature, cases of congenital mydriasis accompanied by coronary artery disease, aortic aneurism, smooth muscle cell dysfunction ( 6), gene mutations (ACTA2) ( 7), Prune Belly syndrome ( 7), septo-optic dysplasia which may be observed in association with cerebrovascular diseases ( 8) and megacystic microcolon intestinal hypoperistaltism syndrome ( 9) have been reported. Lindberg and Brunvand ( 5) reported a 12-year old girl with bilateral congenital mydriasis and aneurismal dilatation of patent ductus arteriosus ( 5). Adie’s tonic pupil, third cranial nerve palsy and pharmacological agents (unilateral use of mydriatic drop) are among the causes of unilateral mydriasis. Other causes which lead to bilateral mydriasis include toxic conditions (atropine intoxication, Parkinson drugs, antidepressants, carbonmonoxide intoxication, cocaine), conditions secondary to morbidities (migraine, schizophrenia, hyperthyroidism, coma) and Parinaud oculoglandular syndrome. Mydriatic pupil observed in the iris which appears to have a normal structure is named congenital mydriasis or familial iridoplegia. The patient was started to be followed up with a prediagnosis of isolated congenital mydriasis considering congenital defect of sphincter efficiency. Assessment performed 45 minutes later showed that no change occurred in the pupillary diameters. ![]() Pilocarpine test (0.1% diluted pilocarpine) was performed for both eyes considering tonic pupil in both eyes. No additional systemic anomaly was found. The laboratory tests of the patient who was evaluated in the department of pediatrics were found to be normal (complete blood count and routine biochemical tests). The eye movements were free and strabismus was not found. The intraocular pressures were found to be normal and fundoscopic examination was found to be normal. On biomicroscopic examination, the iris and other anterior segment findings were observed to be natural. ![]() Absent light reflex, fixed, moderately enlarged and smooth left pupil Diplopia was not described, because mydriasis was congenital.Ībsent light reflex, fixed, moderately enlarged and oval right pupil. On dynamic retinoscopy, it was observed that accommodation was absent. Relative afferent pupillary defect was not found. No difference was observed in the pupillary diameters in the dark and in the light. The pupil was 0.5 mm more dilated in the right eye compared to the left eye (4/3.5 mm). The pupil was moderately enlarged and had a smooth appearance ( Figure 1). In the left eye, light reflex was observed weakly only with very bright light. In the right eye, light reflex was absent, the pupil was fixed, moderately enlarged and had an oval appearance. On opthalmologic examination of the patient who was mentally normal, uncorrected visual acuity was full in both eyes. She had no familial history of pupil anomaly. She had no history of trauma, seizure, surgical intervention related with the eyes or any surgical intervention or use of systemic medication. She had no complaints related with her eyes. It was observed that her brain magnetic resonance imaging was reported to be normal. Iris sphincter traumas, pharmacological dilatation and acquired neurological disorders should be excluded in these patients.Ī 14-year-old female patient presented to our outpatient clinic because of absent pupillary light reflex on neurological examination performed in another center. Fixed and dilated pupil is present from the time of birth, observed more frequently in girls and typically bilateral ( 1– 4). It was described by White and Fulton ( 2) in 1937 for the first time. In this letter, a case presentation has been made to recognize congenital mydriasis, discuss the causes of mydriasis and emphasize the importance of pupil examination.Ĭongenital mydriasis is defined as congenital absence of iris sphincter muscle which occurs rarely and shows autosomal dominant inheritance ( 1– 4).
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