[Anisocoria related to bupropion in migraine].
BACKGROUND
Bupropion is used to help people stop smoking. This drug can cause visual alterations but, up to now, its use was not associated with anisocoria.


METHODS
A 40 year-old woman with a personal history of migraines, presented with monocular mydriasis during treatment with bupropion. Both pupils dilated equally after a 5% cocaine test, and constricted equally after a 0.025% Pilocarpine test. The anisocoria disappeared after the treatment with bupropion was withdrawn.


CONCLUSIONS
Bupropion inhibits neural uptake of norepinephrine and dopamine. Patients with migraine could have a minor unilateral sympathetic pupillary deficit. This deficit could cause hypersensitivity in the oculosympathetic pathway that could be stimulated with bupropion treatment. This feature could explain the mydriasis in our patient. Another explanation could be that bupropion could unmask a physiological anisocoria.
Vleming
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Servicio de Oftalmología del Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España. e_vleming@yahoo.es
Gutiérrez-Ortiz
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Teus
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MA
D000328:Adult; D015875:Anisocoria / Q000139:chemically induced* / Q000175:diagnosis; D016642:Bupropion / Q000009:adverse effects*; D018765:Dopamine Uptake Inhibitors / Q000009:adverse effects*; D005260:Female; D006732:Horner Syndrome / Q000175:diagnosis; D006801:Humans; D008881:Migraine Disorders / Q000150:complications*; D016540:Smoking Cessation
D018765:Dopamine Uptake Inhibitors; D016642:Bupropion