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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Safi A, Schalenbourg A, Kawasaki A. Polycoria in a Young Girl. JAMA Ophthalmol. 2020;138(9):e200656. doi:10.1001/jamaophthalmol.2020.0656
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