A 32-YEAR-OLD white woman sought treatment for a 3-day history of episodic left pupillary distortion associated with blurred vision and abnormal periocular sensations. Attacks lasted between 3and 15 minutes, during which the pupil elongated at the 7-o'clock position (Figure 1). The patient had no headaches or other neurological symptoms or signs. Results of an ophthalmic examination performed between attacks were normal. A single similar episode had occurred 6 months earlier. Her medical history was unremarkable. Although the patient experienced no further attacks, findings from clinical examination, pharmacological testing, and videopupillography performed2 months later (Figure 2)demonstrated ipsilateral preganglionic Horner syndrome.
Photographs of the left eye taken at (A) the start of an episode showing a normal pupil contour, (B) 40 seconds later showing the pupil beginning to peak at the 7-o'clock position, (C) 3 minutes later showing maximal peaking, (D) 5 minutes later, and (E) 7 minutes later showing a return of the normal pupil contour.
Infrared videopupillographic recordings from left (OS) and right (OD) eyes during presentation of a light stimulus. Normal reflex constriction is followed by a redilatation lag in the left eye(arrow), indicating a sympathetic deficit (Horner syndrome). Pharmacological testing with 1% hydroxyamphetamine hydrobromide suggested a preganglionic lesion.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Ophthalmology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 5
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.