Mydriatic pupil in giant cell arteritis.
A mydriatic pupil has been infrequently reported as a manifestation of giant cell arteritis. We report a patient with acute, evolving pupil dilation who was diagnosed with biopsy-proven giant cell arteritis. We document the time course for the development of pupillary near-light dissociation and denervation hypersensitivity. We discuss the possible mechanisms leading to mydriasis, including 1) parasympathetic dysfunction due to ischemia of the ciliary ganglion and post-ganglionic parasympathetic fibers and 2) direct iris ischemia. Repeated episodes of pupil dilation in this patient suggested ongoing microvascular insufficiency.
Division of Neuro-ophthalmology, Department of Neurology, Hospital of the University of Pennsylvania, United States. sashank.prasad@uphs.upenn.edu
Sashank
S
Prasad
Jennifer
J
Baccon
Steven L
SL
Galetta
D000369:Aged, 80 and over; D020757:Amaurosis Fugax / Q000209:etiology; D015875:Anisocoria / Q000209:etiology* / Q000503:physiopathology; D003882:Dermatomyositis / Q000150:complications; D048909:Diabetes Complications; D005726:Ganglia, Parasympathetic / Q000098:blood supply; D013700:Giant Cell Arteritis / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D007498:Iris / Q000098:blood supply / Q000187:drug effects / Q000294:innervation / Q000503:physiopathology; D007511:Ischemia / Q000209:etiology; D008297:Male; D008833:Microcirculation; D017777:Parasympathetic Fibers, Postganglionic / Q000098:blood supply / Q000503:physiopathology; D010862:Pilocarpine; D011111:Polymyalgia Rheumatica / Q000150:complications; D012008:Recurrence; D015845:Tonic Pupil / Q000209:etiology* / Q000503:physiopathology
D010862:Pilocarpine