Book chapter
What Should I Do with a Dilated Pupil?
Consultations in Neuro-Ophthalmology, pp.103-106
CRC Press, Third edition
2026
DOI: 10.1201/9781003632801-22
Abstract
In a patient with unilateral mydriasis, one must first demonstrate that it is isolated, without any accompanying extraocular motility disturbance or ptosis to rule out oculomotor nerve involvement. The next step is to establish whether segmental palsy of the iris sphincter is present using the magnification of a slit lamp exam. If it is segmental, the cause is either a postganglionic parasympathetic denervation (e.g., acute Adie pupil) or, less commonly, direct damage to some segments of the iris sphincter from ischemia, trauma, previous high intraocular pressure, herpes zoster ophthalmicus, or toxicity to the iris. When there is no segmental iris sphincter palsy, one should suspect either pharmacological mydriasis (anticholinergic or sympathomimetic) or sympathetic overactivation associated with migraine.
Details
- Title: Subtitle
- What Should I Do with a Dilated Pupil?
- Creators
- Randy Kardon
- Resource Type
- Book chapter
- Publication Details
- Consultations in Neuro-Ophthalmology, pp.103-106
- Edition
- Third edition
- DOI
- 10.1201/9781003632801-22
- Publisher
- CRC Press; Boca Raton, FL
- Alternative title
- Question 22
- Language
- English
- Date published
- 2026
- Academic Unit
- Iowa Neuroscience Institute; Ophthalmology and Visual Sciences
- Record Identifier
- 9985149568702771
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