Pediatric emergency medicine trisk 0610 0610
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TABLE 29.2
COMMON CAUSES OF UNEQUAL PUPILS a
Physiologic anisocoria
Miosis
Iritis secondary to trauma, juvenile rheumatoid arthritis, or idiopathic
Migraines
Abnormal pupil shape from scar formation following prior iritis or trauma
Horner syndrome (Table 29.4 )
Mydriasis
Trauma
Third cranial nerve palsy
Adie pupil
Congenital abnormalities
Iris coloboma
a Not
listed in order of frequency.
MIOSIS
Local Factors
An irritated or inflamed iris sphincter muscle will result in miosis. Iritis,
secondary to trauma or other factors, is a common cause (see Chapter 27 Eye:
Red Eye ). The eye is usually injected, and there are symptoms of eye pain,
photophobia, tearing, with or without decreased vision. Injection may surround
the cornea for 360 degrees, creating a ring of erythema (“ciliary blush”). More
diffuse injection may also occur ( Fig. 27.5 ). Traumatic iritis is often not
apparent for 12 to 72 hours after eye trauma. Children with juvenile idiopathic
arthritis may not have these classic symptoms associated with their iritis; in fact,
they may have no symptoms at all and may have delayed diagnoses. Iritis from
any cause, especially when longstanding (as is often seen in juvenile idiopathic
arthritis) can result in scar tissues between the pupil edge and the lens just behind
the pupil (posterior synechia), which prevent pupillary dilation or cause
asymmetric irregular dilation of one or both pupils. The diagnosis of iritis is
confirmed by slit-lamp biomicroscopy. This technique is described in Chapter 114
