Post-Traumatic Anisocoria Caused by Iris Sphincter Rupture in a Child: An Unusual Case Report

Abstract

Anisocoria is a rare and unusual post-traumatic condition among eye pathologies. After a traumatic eye injury, the problem can often be masked by complaints of bleeding in the eye and loss of vision. Therefore, anisocoria, which may occur as a result of iris sphincter rupture, should be considered and investigated in the examination, along with other eye examination findings in patients with complaints of traumatic injury to the eye. In this case report, we present a case of a 14-year-old male patient who was investigated for the differential diagnosis of anisocoria in the eye after head trauma and was later diagnosed as iris sphincter rupture.

Keywords

• anisocoria
• trauma
• iris sphincter rupture
• family practice
• primary care

References

1. 1. Payne WN, Blair K, Barrett MJ. Anisocoria. [Updated 2022 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470384/ (Last access date: 27.12.22)
2. 2. Prescott BR, Saglam H, Duskin JA, Miller MI, Thakur AS, Gholap EA, Hutch MR, Smirnakis SM, Zafar SF, Dupuis J, Benjamin EJ, Greer DM, Ong CJ. (2022). Anisocoria and Poor Pupil Reactivity by Quantitative Pupillometry in Patients With Intracranial Pathology. Crit Care Med. 1;50(2):e143-e153. doi: 10.1097/CCM.0000000000005272.
3. 3. Steck RP, Kong M, McCray KL, Quan V, Davey PG. (2018). Physiologic anisocoria under various lighting conditions. Clin Ophthalmol. Jan 4;12:85-89. doi: 10.2147/OPTH.S147019
4. 4. Martin TJ. (2018) Horner Syndrome: A Clinical Review. ACS Chem Neurosci. 21;9(2):177-186. doi: 10.1021/acschemneuro.7b00405.
5. 5. Yoo YJ, Hwang JM, Yang HK. (2021). Dilute pilocarpine test for diagnosis of Adie's tonic pupil. Sci Rep. 12;11(1):10089. doi: 10.1038/s41598-021-89148-w.
6. 6. Gross, JR, Collin MM, and Michael SL. (2016). "An approach to anisocoria." Current opinion in ophthalmology 27, 6: 486-492.
7. 7. Kaufman AR, Gulati S, Curnyn KM. (2020). Pharmacologic anisocoria secondary to topical glycopyrronium for axillary hyperhidrosis: an emerging clinical presentation. Can J Ophthalmol. Oct;55(5):464. doi: 10.1016/j.jcjo.2020.06.009.
8. 8. Derinoz-Guleryuz O, Fidanci İ, Men-Atmaca Y. (2021). Nebulized Ipratropium Bromide-induced Anisocoria: Why Is Anisocoria Observed? Iran J Allergy Asthma Immunol. 11;20(1):125-128. doi: 10.18502/ijaai.v20i1.5420

9. 9. Woischneck D, Schmitz B, Kapapa T. (2017). MRI detection of cerebral lesions in post-traumatic anisocoria: specificity and prognostic significance. Clin Radiol. 72(5):426.e7-426.e15. doi: 10.1016/j.crad.2016.11.011.
10. 10. Nyancho D, Atem FD, Venkatachalam AM, Barnes A, Hill M, Traylor JI, Stutzman SE, Bedros N, Aiyagari V, Aoun SG. (2021). Anisocoria Correlates with Injury Severity and Outcomes After Blunt Traumatic Brain Injury. J Neurosci Nurs. 1;53(6):251-255. doi: 10.1097/JNN.0000000000000613.
11. 11. Pujari A, Agarwal D, Kumar Behera A, Bhaskaran K, Sharma N. (2019). Pathomechanism of iris sphincter tear. Med Hypotheses. 122:147-149. doi: 10.1016/j.mehy.2018.11.013.