Unilateral mydriasis

This is a straightforward diffential, so that you won’t find any recent reviews on the topic. We are stuck with our textbooks – you can probably judge the  quality and the uptodateness of your favorite textbook by it’s handling of this classic question.

Here are some remarks:

  •  Anisokoria: You can use apraclonidine if you have it to find out which side is the bad one.
  • Pathologically small: DD of Horner’s – too broad (separate CME session)
  • Pathologically big: can be pharmacological (use Pilocarpine to prove that further anti-M3 doesn’t change the big pupil), ophthalmological (use slit slamp), Adie’s/Ross syndrome or symptomatic ciliar ganglion disease (only after reinnervation the denervated pupil becomes tonic and accommodating, whereas in the acute phase often both is not true), peripheral oculomotor (compression mostly, can occur w/o other third nerve problems), mesencephalic.
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