J Korean Ophthalmol Soc.  2019 Sep;60(9):901-904. 10.3341/jkos.2019.60.9.901.

An Unusual Case of Benign Episodic Bilateral Mydriasis

Affiliations
  • 1Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. ophdrchoi@gmail.com
  • 2Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Although benign episodic mydriasis has been rarely reported worldwide, most of the reports so far have occurred in unilaterally. To report an unusual case of benign episodic bilateral mydriasis.
CASE SUMMARY
Nineteen-year-old woman who presented with intermittent dilation of both pupils two months ago. She had difficulty on reading and doing tasks because of her visual blur. This symptom usually lasted for 1-2 hours, occurred once every 2-3 days, most frequently during stressful situations. Headaches and dizziness accompanied the eye symptoms, and her pupils were both 5 mm in a lighted room and both 7 mm in a dark room. All tests, including brain magnetic resonance imaging, showed no abnormal findings. We diagnosed her as benign episodic bilateral mydriasis. The frequency of her symptoms decreased during the university vacation period.
CONCLUSIONS
In the absence of ophthalmologic or neurologic abnormalities other than headaches in patients with transient mydriasis, benign episodic mydriasis should be considered as a differential diagnosis. Although benign episodic bilateral mydriasis has a unilateral predominance, for the first time the authors report that benign episodic mydriasis may occur in both eyes during same episode.

Keyword

Benign episodic mydriasis; Mydriasis; Pupil

MeSH Terms

Brain
Diagnosis, Differential
Dizziness
Female
Headache
Humans
Magnetic Resonance Imaging
Mydriasis*
Pupil

Figure

  • Figure 1 Episodic bilateral mydriasis. Both pupils dilated during an episode. (A) Facial photo of the patient in room light during an episode (B) slit-lamp photo of right eye in room light during an episode. (C) Slit-lamp photo of left eye in room light during an episode. Except for the mydriasis, the response to the light stimulation was normal that immediately contracted, so the two sides were shot as if they were dilated slightly differently due to the momentary pupil response to the flash light during the photo shoot, but the both sides were dilated to the same degree in actual observation.


Reference

1. Hallett M, Cogan DG. Episodic unilateral mydriasis in otherwise normal patients. Arch Ophthal. 1970; 84:130–136.
Article
2. Woods D, O'Connor PS, Fleming R. Episodic unilateral mydriasis and migraine. Am J Ophthalmol. 1984; 98:229–234.
Article
3. Jacobson DM. Benign episodic unilateral mydriasis. Clinical characteristics. Ophthalmology. 1995; 102:1623–1627.
4. Edelson RN, Levy DE. Transient benign unilateral pupillary dilation in young adults. Arch Neurol. 1974; 31:12–14.
Article
5. Skeik N, Jabr FI. Migraine with benign episodic unilateral mydriasis. Int J Gen Med. 2011; 4:501–503.
Article
6. Chadha V, Tey A, Kearns P. Benign episodic unilateral mydriasis. Eye (Lond). 2007; 21:118–119.
Article
7. Martin-Santana I, González-Hernández A, Tandón-Cárdenes L, López-Méndez P. Benign episodic mydriasis. Experience in a specialist neuro-ophthalmology clinic of a tertiary hospital. Neurologia. 2015; 30:290–294.
8. Dimascio A, Buie DH Jr. Psychopharmacology of chlorphentermine and d-amphetamine. A comparative study of their effects in normal males. Clin Pharmacol Ther. 1964; 5:174–184.
Article
9. Abokyi S, Owusu-Mensah J, Osei KA. Caffeine intake is associated with pupil dilation and enhanced accommodation. Eye (Lond). 2017; 31:615–619.
Article
10. Blanchard J, Sawers SJ. The absolute bioavailability of caffeine in man. Eur J Clin Pharmacol. 1983; 24:93–98.
Article
11. Margari L, Legrottaglie AR, Craig F, et al. Ophthalmoplegic migraine: migraine or oculomotor neuropathy? Cephalalgia. 2012; 32:1208–1215.
Article
12. Sobreira I, Sousa C, Raposo A, et al. Ophthalmoplegic migraine with persistent dilated pupil. J Child Neurol. 2013; 28:275–276.
Article
13. van Engelen BG, Renier WO, Gabreëls FJ, Cruysberg HR. Bilateral episodic mydriasis as a migraine equivalent in childhood: a case report. Headache. 1991; 31:375–377.
Article
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