Isocoria with Dilated Pupils

 Parinaud’s Oculoglandular Syndrome

Causes: 

Tumors such as pineal gland tumors that selectively damage fibersbetween the pretectal nuclei and the Edinger-Westphal nucleus.

Diagnostic considerations:

❖ Fixed dilated pupils that do not respond to light.

❖ Normal near reflex.

❖ Limited upward gaze (due to damage to the vertical gaze center) and retraction nystagmus.

Intoxication

Causes: 

Atropine, spasmolytic agents, anti-parkinson agents, antidepres-sants, botulism (very rare but important), carbon monoxide, cocaine.

Disorders

❖ Migraine.

❖ Schizophrenia.

❖ Hyperthyreosis.

❖ Hysteria.

❖ Epileptic seizure.

❖ Increased sympathetic tone (Bumke’s anxiety pupils).

❖ Coma.

❖  Agony.

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