NANOSNET

I am seeing a 37-year-old patient who noticed an irregular pupil OS while plucking her eyebrows in January. She started tirzepatide 2 months prior which I suspect is unrelated and I could not find any reports of this in PubMed. She also takes spironolactone (for hidradenitis suparativa) and has eczema that is treated with topicals as needed. There is no history of trauma or uveitis. She is certain that it is not congenital.

Exam showed symmetric pupils in light (2 mm) and dark (4 mm) other than the area of corectopia OS superonasally. Both pupils react to light and briskly to near. No RAPD. Slit lamp exam was normal except for a very thin pupillary ruff bilaterally (although she hasn't been dilated yet due to pharmacologic pupil testing). No sectoral iris sphincter palsy with high mag view. MRI of the brain was normal except for pituitary flattening and her exam is otherwise normal.

Dilute pilocarpine and apraclonidine tests were negative.

I have a photo if someone can tell me how to post it...

Is there anything else I should be looking for?

Thanks!

Deb

I am seeing a 37-year-old patient who noticed an irregular pupil OS while plucking her eyebrows in January. She started tirzepatide 2 months prior which I suspect is unrelated and I could not find any reports of this in PubMed. She also takes spironolactone (for hidradenitis suparativa) and has eczema that is treated with topicals as needed. There is no history of trauma or uveitis. She is certain that it is not congenital.

Exam showed symmetric pupils in light (2 mm) and dark (4 mm) other than the area of corectopia OS superonasally. Both pupils react to light and briskly to near. No RAPD. Slit lamp exam was normal except for a very thin pupillary ruff bilaterally (although she hasn't been dilated yet due to pharmacologic pupil testing). No sectoral iris sphincter palsy with high mag view. MRI of the brain was normal except for pituitary flattening and her exam is otherwise normal.

Dilute pilocarpine and apraclonidine tests were negative.

I have a photo if someone can tell me how to post it...

Is there anything else I should be looking for?

Thanks!

Deb

I am seeing a 37-year-old patient who noticed an irregular pupil OS while plucking her eyebrows in January. She started tirzepatide 2 months prior which I suspect is unrelated and I could not find any reports of this in PubMed. She also takes spironolactone (for hidradenitis suparativa) and has eczema that is treated with topicals as needed. There is no history of trauma or uveitis. She is certain that it is not congenital.

Exam showed symmetric pupils in light (2 mm) and dark (4 mm) other than the area of corectopia OS superonasally. Both pupils react to light and briskly to near. No RAPD. Slit lamp exam was normal except for a very thin pupillary ruff bilaterally (although she hasn't been dilated yet due to pharmacologic pupil testing). No sectoral iris sphincter palsy with high mag view. MRI of the brain was normal except for pituitary flattening and her exam is otherwise normal.

Dilute pilocarpine and apraclonidine tests were negative.

I have a photo if someone can tell me how to post it...

Is there anything else I should be looking for?

Thanks!

Deb

I am seeing a 37-year-old patient who noticed an irregular pupil OS while plucking her eyebrows in January. She started tirzepatide 2 months prior which I suspect is unrelated and I could not find any reports of this in PubMed. She also takes spironolactone (for hidradenitis suparativa) and has eczema that is treated with topicals as needed. There is no history of trauma or uveitis. She is certain that it is not congenital.

Exam showed symmetric pupils in light (2 mm) and dark (4 mm) other than the area of corectopia OS superonasally. Both pupils react to light and briskly to near. No RAPD. Slit lamp exam was normal except for a very thin pupillary ruff bilaterally (although she hasn't been dilated yet due to pharmacologic pupil testing). No sectoral iris sphincter palsy with high mag view. MRI of the brain was normal except for pituitary flattening and her exam is otherwise normal.

Dilute pilocarpine and apraclonidine tests were negative.

I have a photo if someone can tell me how to post it...

Is there anything else I should be looking for?

Thanks!

Deb

I am seeing a 37-year-old patient who noticed an irregular pupil OS while plucking her eyebrows in January. She started tirzepatide 2 months prior which I suspect is unrelated and I could not find any reports of this in PubMed. She also takes spironolactone (for hidradenitis suparativa) and has eczema that is treated with topicals as needed. There is no history of trauma or uveitis. She is certain that it is not congenital.

Exam showed symmetric pupils in light (2 mm) and dark (4 mm) other than the area of corectopia OS superonasally. Both pupils react to light and briskly to near. No RAPD. Slit lamp exam was normal except for a very thin pupillary ruff bilaterally (although she hasn't been dilated yet due to pharmacologic pupil testing). No sectoral iris sphincter palsy with high mag view. MRI of the brain was normal except for pituitary flattening and her exam is otherwise normal.

Dilute pilocarpine and apraclonidine tests were negative.

I have a photo if someone can tell me how to post it...

Is there anything else I should be looking for?

Thanks!

Deb

I am seeing a 37-year-old patient who noticed an irregular pupil OS while plucking her eyebrows in January. She started tirzepatide 2 months prior which I suspect is unrelated and I could not find any reports of this in PubMed. She also takes spironolactone (for hidradenitis suparativa) and has eczema that is treated with topicals as needed. There is no history of trauma or uveitis. She is certain that it is not congenital.

Exam showed symmetric pupils in light (2 mm) and dark (4 mm) other than the area of corectopia OS superonasally. Both pupils react to light and briskly to near. No RAPD. Slit lamp exam was normal except for a very thin pupillary ruff bilaterally (although she hasn't been dilated yet due to pharmacologic pupil testing). No sectoral iris sphincter palsy with high mag view. MRI of the brain was normal except for pituitary flattening and her exam is otherwise normal.

Dilute pilocarpine and apraclonidine tests were negative.

I have a photo if someone can tell me how to post it...

Is there anything else I should be looking for?

Thanks!

Deb