A 32-YEAR-OLD white woman sought treatment for a 3-day history of episodic left pupillary distortion associated with blurred vision and abnormal periocular sensations. Attacks lasted between 3and 15 minutes, during which the pupil elongated at the 7-o'clock position (Figure 1). The patient had no headaches or other neurological symptoms or signs. Results of an ophthalmic examination performed between attacks were normal. A single similar episode had occurred 6 months earlier. Her medical history was unremarkable. Although the patient experienced no further attacks, findings from clinical examination, pharmacological testing, and videopupillography performed2 months later (Figure 2)demonstrated ipsilateral preganglionic Horner syndrome.
Balaggan KS, Hugkulstone CE, Bremner FD. Episodic Segmental Iris Dilator Muscle SpasmThe Tadpole-Shaped Pupil. Arch Ophthalmol. 2003;121(5):744-745. doi:10.1001/archopht.121.5.744