A 39-year-old woman presented to the emergency department after she noticed that her left pupil was dilated when looking in the mirror earlier in the day. She had a medical history of hypertension and palmar and axillary hyperhidrosis. She denied double vision, ptosis, headache, and weakness. On examination, she appeared well and her blood pressure was 128/78 mm Hg; heart rate, 76/min; and respiratory rate, 13/min. Visual acuity was 20/20 in both eyes, there was no ptosis, and extraocular movements were full. Pupillary examination revealed anisocoria that was more pronounced in bright lighting conditions (Figure). The right pupil measured 6 mm in the dark and 3 mm in the light, whereas the left pupil measured 9 mm in the dark and 8 mm in the light. The left pupil was poorly reactive to light and to a near target. Slitlamp examination revealed normal-appearing anterior chambers without any signs of intraocular inflammation. Cranial nerve function was otherwise normal. The remainder of the neurologic examination revealed normal muscle tone, strength, reflexes, and gait.
Micieli R, Micieli JA. Dilated Pupil in a Patient With Hyperhidrosis. JAMA. 2019;322(3):264–265. doi:10.1001/jama.2019.8589
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