PMC6709659_01
(A,B) Right eye of patient 1 during two episodes of tadpole pupil. Note the oval-shaped deformation of the pupil. (C) Between episodes, an anisocoria with a smaller right pupil and right upper lid ptosis was noted.
fneur-10-00846-g0001.jpg
PMC6709659_01_fneur-10-00846-g0001.jpg
F1
The pupil became tear-shaped or oval-shaped then returned to a round shape within 1 min (Figures 1A,B). Recently, the patient noted right upper eyelid ptosis and a smaller right pupil (Figure 1C).
PMC6709659_02
(A) Left eye of patient 2 during one episode of tadpole pupil. Note the tear-shaped deformation of the pupil. (B) Between episodes, examination showed an anisocoria with left pupillary miosis. (C) The anisocoria had been noticed by the patient for 15 years, as shown in this photograph taken 15 years previously.
fneur-10-00846-g0002.jpg
PMC6709659_02_fneur-10-00846-g0002.jpg
F2
A 41-year-old healthy woman noted painless episodic distortion of her left pupil (Figure 2A).The pupillary distortion occurred three to four times in 1 week and each episode lasted <1 min without other accompanying symptoms. A review of old photographs dated this anisocoria to 15 years prior (Figure 2C). Ophthalmologic examination was normal except for an anisocoria with left pupillary miosis (Figure 2B).
PMC6709659_03
(A) Right eye of patient 3 during different episodes of tadpole pupil. This patient experienced painless episodic distortion of her right pupil accompanied by blurry vision. The pupillary distortion varied with each episode. (B) Between episodes, the patient demonstrated an anisocoria with a smaller right pupil; however, the larger left pupil was poorly reactive to light. Dilute pilocarpine testing (not shown) revealed cholinergic hypersensitivity of the left pupil indicating a left Adie pupil.
fneur-10-00846-g0003.jpg
PMC6709659_03_fneur-10-00846-g0003.jpg
F3
She also noted that the pupillary distortion frequently occurred in a different clock sector with each episode (Figure 3A). The neurologic and ophthalmologic examinations were normal except for anisocoria with right pupillary miosis (Figure 3B).
PMC6709659_04