“We see a lot of these people in neuro-ophthalmology,” Dr. Friedman said. “They may be either young athletes, particularly men, or people in their 50s or 60s who all of a sudden have a flurry of transient monocular visual loss. The physiology in those cases may be related to vasospasm, but they don’t meet the criteria for so-called retinal migraine, because they don’t have headaches.”
Benign Episodic Unilateral Mydriasis
Benign episodic pupillary mydriasis is an episode of pupillary dilation that lasts from 12 hours to weeks and is sometimes accompanied by problems with near vision. “It’s thought that this could represent sympathetic hyperactivity of the iris dilator or, conversely, parasympathetic insufficiency of the iris sphincter,” Dr. Friedman said. The major differential diagnosis for the disorder is Adie pupil; treatment with pilocarpine usually results in pupil constriction with Adie pupil but has no response with benign episodic pupillary mydriasis.
“The major thing to know about benign episodic pupillary mydriasis is that it’s a benign condition,” Dr. Friedman said. “You can reassure the patient, and you don’t need to send him or her for an angiogram.”
—Jack Baney