ABSTRACT
A 50-year-old male with no prior medical history, but with a history of heavy smoking, presents to the local ophthalmology office on referral from his internist for large right pupil. The patient has not noticed it previously. He has no other complaints. Visual acuity is 20/20 in each eye, confrontation visual fields, motility, are normal. The pupils are shown below in Figures 17.1 and 17.2, with anisocoria greater in dark than in light. There appears to be a subtle, but uncertain, dilation lag on the left. There is no prior history of surgery or trauma to suggest this anisocoria is due to iris sphincter damage. The patient wants to know if this could be serious and how soon he can find out.
