Observation: 1

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You are asked to carry out pupillary examination on this  patient. Observation reveals this appearance. What is the likely diagnosis? Answer The patient has anisocoria without heterochromia or ptosis.  These exclude Horner's or third nerve palsy. The patient may have physiological anisocoria but this is uncommon in the examination as most of the patients given have an underlying pathology  Pharmacological anisocoria is also uncommon in pupil  examination unless the examiner runs out of suitable patients  and give you a patient who has had one pupil dilated  for fundoscopy. The main diagnosis are either Adie's pupil or traumatic  mydriasis in the right dilated eye or posterior synechiae from previous iritis in the left eye. This patient has a right Adie's pupil (this is commoner than trauma or posterior synechiae in the setting of examination). Return to observation