Paradoxical pupillary reactions have been classified by Piltz1 as: (1) paradoxical dilatation with near vision or with constriction of the pupil in distant vision, (2) true paradoxical pupillary reaction with dilatation on exposure to light or constriction of the pupil when light is withdrawn. In either case, this is an exceedingly rare phenomenon,2 the existence of which has been questioned, with the reported observations attributed to relaxation of convergence, lid reflexes, or psychosensory responses.3,4
The following is a report of a case of true paradoxical pupillary reaction.
Report of a Case
The patient, a 30-year-old right-handed white woman was seen by the Ophthalmology Consult Service of Barnes Hospital, Washington University Medical Center on July 24, 1964, because of an inequality of pupils noted by the patient on looking in a mirror.The past history revealed that in January 1963 the patient was involved in an auto accident
FREEMAN MI, BURDE RM, GAY AJ. A Case of True Paradoxical Pupillary Reaction. Arch Ophthalmol. 1966;75(6):740-741. doi:10.1001/archopht.1966.00970050742003