University of Wisconsin–Madison ⋅ Medical College of Wisconsin
WMJ

Anisocoria Following Uncomplicated Cataract Surgery

Jennifer Larson, MD; Madeline Arzbecker, BS

WMJ. 2024;123(3); published online in advance June 3, 2024.

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ABSTRACT

Introduction: In this report, we describe a case of anisocoria following uncomplicated cataract surgery. Clinicians should consider postoperative mechanical and tonic pupils when evaluating patients with anisocoria.

Case Presentation: A 69-year-old White female underwent uncomplicated cataract surgery of her left eye. No intraoperative pupil expansion devices were used, and no floppy iris or iris prolapse occurred during the surgery. Postoperatively, she was found to have anisocoria. Pharmacologic pupillary testing confirmed a tonic and mechanical left pupil.

Discussion: There have been no reported causes of anisocoria from a tonic pupil after cataract surgery. Based on reports of tonic pupils following other eye surgeries, our case likely occurred from a combination of parasympathetic dysfunction and mechanical trauma.

Conclusions: To our knowledge, this is the first report of a tonic pupil following cataract surgery, thus expanding the literature of causes of anisocoria that may be underrecognized in the clinical setting.

Author Affiliations: Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Larson, Arzbecker).
Corresponding Author: Jennifer Larson, MD, Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, 2880 University Ave, Madison, WI 53705; phone 608-263-7171 (phone), email jciske@wisc.edu; ORCID ID 0000-0001-5205-1529
Funding/Support: This work was supported in part by an unrestricted grant from Research to Prevent Blindness, Inc to the University of Wisconsin School of Medicine and Public Health Department of Ophthalmology and Visual Sciences.
Financial Disclosures: None declared.
Acknowledgements: The patient in this case gave verbal consent to publish the case. This report contains no personal information that could lead to her identification.
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