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Ophthalmic Images
September 10, 2020

Polycoria in a Young Girl

Author Affiliations
  • 1Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland
  • 2Cliniques Universitaires Saint Luc, Brussels, Belgium
  • 3University of Lausanne, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland
JAMA Ophthalmol. 2020;138(9):e200656. doi:10.1001/jamaophthalmol.2020.0656

A 9-year-old girl in good health was noted to have 2 holes in her left iris on a routine examination. The presence of multiple iris holes is most commonly called pseudopolycoria, because only the central pupil has a sphincter muscle and can constrict. Iris holes without muscle tissue arise as congenital defects or develop from ocular trauma, inflammation, or degeneration and are thus not considered to be true accessory pupils. Multiple pupils, also known as true polycoria, are distinguished by the presence of a sphincter muscle around each iris hole, permitting synchronous constriction and dilation of the 2 pupils.1 One presumed mechanism for polycoria is a snaring or pinching off from the margin of another pupil.2 This patient had a small, oval-shaped accessory pupil, which may have separated from the temporal margin of the central pupil, leaving a thin bridge of nonsphincter connecting tissue (Figure). The Video shows the synchronous movements of the polycoria.

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1 Comment for this article
About the Polycoria case
Sumitra Kumar Biswas, MS MCh (Pediatric Surgery) | Visiting Professor, Institute of Child Health, Kolkata, India
This case does not seem to be true polycoria because

(1) the rent is less than 2.5 mm away from pupil margin proper;
(2) its thin fringe is not contracting;
(3) the rent is becoming narrower because of the pupillary muscle contraction as a whole;
(4) separate circular muscle orientation should be documented by HRUSG/MR imaging