Bitemporal palsy of the pupillary sphincters caused by iris ischemia

Abstract

We present the case of a 55-year-old man who complained of glare after an acute episode of severe headache. Neurological evaluation was normal. Ophthalmological examination revealed oval-shaped pupils bilaterally. Fluorescein iris angiography showed diminished iris circulation in the lower temporal sectors bilaterally. The oval-shaped pupils are likely due to a local palsy of the pupillary sphincters related to ischemic changes in these areas. The localization may be explained by the particular characteristics of the iris vascular network. To our knowledge, there have only been three previous similar reports in patients with advanced atherosclerosis. Our report documents, for the first time, fluorescein iris angiography changes associated with this condition.