Ipsilateral Mydriasis Research Articles

Pre-rupture syndrome

Oculomotor nerve palsy can be a strong indicator of an internal carotid artery aneurysm, specifically of the posterior communicating artery, due to the anatomical positioning within the basal cisterns of the subarachnoid space, which allows for nerve compression. This condition can predict an acute subarachnoid haemorrhage, associated with a high mortality rate, often presenting with sudden, severe headaches, with or without deficits. The pathophysiology theories include direct mechanical compression by the aneurysmal sac, arterial pulsations, and nerve tissue oedema from venous obstruction. In cases of unruptured aneurysms, nerve irritation is less common. This palsy occurs in about one-third of cases. Aneurysmal orientation can vary (lateral, superior, inferior, medial, posterior), and due to the nerve’s anatomical position, aneurysms in the postero-lateral-inferior position are more likely to cause nerve damage. Treatment opinions vary from observation to intervention, with options including traditional neurosurgery and endovascular embolization. The latter is increasingly preferred due to its efficacy and lower risk profile. A clinical case involves a 56-year-old female presenting with ptosis, diplopia, and ipsilateral mydriasis. Imaging confirmed a posterior communicating artery aneurysm with a maximum diameter of 5.3 mm and a 3 mm bleb. Endovascular coiling was performed successfully, excluding the aneurysm from circulation without complications. Post-treatment, the patient was discharged in good condition with recommendations for periodic monitoring. In conclusion, while no single best treatment exists for posterior communicating artery aneurysms with oculomotor nerve palsy, early intervention (surgical or endovascular) and patient monitoring are crucial for preventing complications and ensuring quality of life.

Unilateral Oculomotor Nerve Palsy as a Rare Manifestation of Isolated Pre-Communicating Segment of Posterior Cerebral Artery Thrombosis.

Ipsilateral mydriasis (IM) is usually not acute. However, the acute occurrence of unilateral dilated pupil may result in acute ischemic stroke. Herein, we present 3 patients with IM, lateral eye deviation, ptosis, and contralateral hemiparesis due to isolated occlusion of the pre-communicating segment of the posterior cerebral artery with preservation of the posterior communicating artery, which was successfully treated by emergent mechanical thrombectomy. In a 3-month follow-up, all patients were independent without any neurological deficits.

Transient Ipsilateral Mydriasis During Correction of Left Blowout Fracture

Mydriasis, either bilateral or unilateral, seldom occurs during reconstruction of periorbital fracture. Anisocoria, a unilateral mydriasis, requires more urgent assessment than bilateral mydriasis does. Pharmacologic agents, local anesthetic infiltration, as well as direct or indirect oculomotor nerve damage are possible causes of unilateral mydriasis. Few cases have been reported about intraoperative temporary ipsilateral mydriasis during correction of blowout fracture. We have experienced an unusual case of anisocoria and report the case with literature reviews.

Transdermal Scopolamine and Perioperative Anisocoria in Craniofacial Surgery

Postoperative nausea and vomiting (PONV) is a common complaint after plastic and reconstructive surgery. Transdermal scopolamine is a commonly used agent for prevention of PONV. Anisocoria from transdermal scopolamine use is an adverse effect that has not been reported in the plastic surgery literature. We present a series of 3 craniofacial patients in which ipsilateral mydriasis occurred and spontaneously resolved after removal of the scopolamine patch. Given the various causes and potentially grave implications of unilateral mydriasis, we discourage the use of transdermal scopolamine in craniofacial surgery, and especially in orbital surgery. However, if transdermal scopolamine is decided to be used for PONV prophylaxis, we recommend educating the patient, the operating room staff, and the surgical team regarding this potential adverse effect and to avoid finger-to-eye contamination after patch manipulation.

Pourfour du Petit Syndrome Associated With a Cervical Vertebral Anomaly

Pourfour du Petit syndrome is a rare dysautonomic disorder characterized by mydriasis, eyelid retraction, and hyperhidrosis and is caused by irritative stimulation of the sympathetic cervical chain. The authors describe a 45-year-old woman with iris heterochromia, who presented with episodes of ipsilateral mydriasis and hyperhidrosis and was found to have a cervical vertebral anomaly, probably present since birth, as the cause of Pourfour du Petit syndrome.

Ciliary ganglioplegic migraine: Migraine-related prolonged mydriasis

Transient, unilateral mydriasis has been reported in migraine patients, and this has been regarded as a possible co-morbidity between migraine and Adie's tonic pupil. Mydriasis that outlasts the duration of migraine attacks is rare. Through an eight-year period we have studied all patients referred to our neurological clinic because of migraine attack with mydriasis. All the patients underwent thorough neurologic and ophthalmologic examinations including MRI of the brain and testing of the pupil response to ocular instillation of dilute pilocarpine (0.125%). Seven women and two men, with a mean age of 33.8 ± 12.3 years (range: 19-52) were included. The patients presented during one hemicranial migraine attack with an ipsilateral mydriasis that persisted for a mean of three months, while migraine headaches remained with their typical episodic course. In all the patients a cholinergic supersensitivity in the symptomatic pupil was demonstrated, thus pointing to a dysfunction of the ipsilateral ganglionic parasympathetic fibers. Synchronous co-localization of the features suggests a pathogenic link between the pupil dysfunction and migraine, rather than a simultaneous coexistence of two independent disorders. Likely explanations include a latent Adie's pupil that could have been triggered during a particular migraine attack; a ciliar ganglionic lesion/dysfunction produced by the migrainous process; an ophthalmoplegic migraine with selective parasympathycoparesis; or an episodic ciliar ganglionitis with migrainous features. Ciliary ganglioplegic migraine is proposed as a nominal term pointing to the possible anatomic source of the migrainous-related pupil dysfunction; the pathogenesis remains unknown.

Trigeminocardiac reflex and ipsilateral mydriasis during stereotactic brain tumor biopsy: an insight into the anatomical and physiological pathways involved

Trigeminocardiac reflex and ipsilateral mydriasis during stereotactic brain tumor biopsy: an insight into the anatomical and physiological pathways involved

Ipsilateral Mydriasis after Open Reduction of a Left Blow Out Fracture: A case report

Ipsilateral Mydriasis after Open Reduction of a Left Blow Out Fracture: A case report

Effect of botulinum toxin injections into rabbit eye

The aim of this study was to investigate the adverse effects of the intraocular injection of botulinum toxin in rabbits. Intravitreal injections of botulinum toxin A in five doses, 1.25, 2.5, 5, 10, 25 units, were given into five rabbit eyes. The same volume of saline was injected into the second eye of the rabbit as a control. External examination, ophthalmoscopy, visual evoked potentials and electroretinography were done before injection and repeated at the first and second weeks after the injection. There were no significant differences in retinal function between toxin- and saline-injected eyes, neither ophthalmoscopically nor electrophysiologically. Ipsilateral mydriasis developed in the eyes injected with botulinum toxin. This study suggests that botulinum toxin has no harmful effect on retinal function.

NALOXONE EYE DROPS REVERSE THE MIOSIS IN RUNNERS - IMPLICATIONS FOR AN ENDOGENOUS OPIATE TEST

0.16% ophthalmic drops or placebo drops were self-administered to one eye by 13 runners 250 times in a double-blind fashion over three weeks of various intensities and durations of running. An increasing incidence of miosis after running and ipsilateral mydriasis after the naloxone eye drops were administered was noted to correlate with increased run durations. During 34 runs of over 30 minutes duration, 20 subject runs (59%) developed miosis in both eyes and mydriasis in the eye treated with naloxone, but none of 10 subject runs over 30 minutes (9 of which showed miosis) developed mydriasis after placebo drop administration. Calculations (means, SEM) of pupil sizes in various run durations revealed an increased occurrence of miosis which was reversed with naloxone in over 30 minute runs at a significance level greater than 0.005 (single tailed t test). It is suggested that exercise generated endogenous opiates cause pupillary miosis, and that ophthalmic naloxone to one eye can block this exercise pupillary effect resulting in ipsilateral mydriasis. Suggestions are given for a simple Naloxone Anisocoria Test for the presence or absence of elevated endogenous opiates.