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A 15-year-old girl with variable anisocoria
Digital Journal of Ophthalmology 2014
Volume 20, Number 1
January 12, 2014
DOI: 10.5693/djo.03.2013.10.001
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Robert L. Tomsak MD, PhD | Department of Ophthalmology, Kresge Eye Institute, Wayne State University
Michael J. Coleman, MD | Department of Ophthalmology, Kresge Eye Institute, Wayne State University



Differential Diagnosis
Evaluation of unilateral mydriasis can be a diagnostic dilemma and could be a medical emergency in the setting of compressive oculomotor nerve palsy. In the clinical setting, evaluation of extraocular movements is essential to determine whether an oculomotor nerve palsy is causing an acute unilateral mydriasis. Once this has been ruled out, Adie’s tonic pupil must be considered. Other causes of mydriasis and accommodative failure include temporal lobe epilepsy,(1) migraine,(2,3) use of topical and systemic medications,(4-6) or exposure to plant toxins.(7,8)
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