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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



Treatment
We elected to proceed with pharmacologic testing with 0.125% pilocarpine. This demonstrated bilateral pupillary constriction suggestive of cholinergic receptor suprasensitivity in both eyes. She was diagnosed with a variant of Adie’s tonic pupil in each eye, and she was reassured.

Three weeks later she was reexamined because of a worsening of her symptoms. On follow-up examination, her pupils were 8 mm and nonreactive to light, accommodation, or 1% pilocarpine. Distance visual acuity was 20/20 with correction and near acuity was J7 with correction and J2 without correction.
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