Ocular Effects of the Sympathetic Nervous System

Case 4

A patient entered the examination room with a complaint of unequal pupil sizes, X 1 month.  Upon questioning, the patient revealed that this condition had been constant, and that the left pupil was smaller than the right.  No other symptoms had been noted.

The doctor performed VAs, manifest refraction, and an ocular health examination, which were unremarkable.

The chair skill evaluation yielded the following results:

• Pupils: unequal (dim light: OD 7mm, OS 6mm; bright light: OD 4mm, OS 3mm), round, reactive to light and accommodation OU
• Eyelid position:
  • Right upper lid (RUL) and left upper lid (LUL) positions are equal
  • Right lower lid (RLL) and left lower lid (LLL) positions are equal
• Interpalpebral distance (IPD):
  • Right IPD: 9mm
  • Left IPD: 9mm

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Question 7

Based on the information in case 4, what is the most-appropriate diagnosis?

Click the appropriate answer.

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