Tonic pupil with giant cell arteritis.

Giant cell arteritis: ophthalmic manifestations of a systemic disease

“…Tonic pupils are a rare complication of GCA as the ciliary ganglion usually has an anastomotic blood supply from between one and four arteries and is based on a network of capillaries ( Figure 3b) [51,52]. Tonic pupils in GCA are characterised by poor pupillary reactivity to light, slow and tonic constriction to a near target (disproportionately better than response to light) and accommodative paresis [53].…”

Holmes-Adie pupil in a patient with hemicrania: a spectrum of a multifocal autonomic dysfunction?

“…Denervation super-sensitivity of the iris muscles from lesion of the postganglionic parasympathetic pathways is thought to be the imputed mechanism of such disorder 3 . Rarely it may be secondary to the remote effects of malignancy, primary Sjögren syndrome and temporal arteritis [4][5][6] . In this patient, there were no findings to support these conditions, nor primary ophthalmologic diseases, such as open angle glaucoma or uveitis that potentially could have explain her headache and pupillary changes.…”

Mydriatic pupil in giant cell arteritis

“…We report the rare occurrence of GCA-related anisocoria without motility deficits, presumably due to microvascular ischemia of either the ciliary ganglion and post-ganglionic parasympathetic fibers or the iris sphincter itself [2][3][4][5][6][7]. Multiple recurrences of the patient's dilated pupil suggested ongoing microvascular insufficiency.…”