Tonic Pupil in Cytomegalovirus Anterior Uveitis in an Immunocompetent Adult Male - A Case Report

Abstract

Purpose: To report an interesting case of development of tonic pupil in an immunocompetent male with cytomegalovirus (CMV) anterior uveitis.

Methods: Retrospective case report Results: A 30-year-old Iranian healthy male was diagnosed to have Posner-Schlossman syndrome (OS). Aqueous tap was positive for CMV by multiplex Polymerase chain reaction (PCR). Adequate control of inflammation and Intraocular pressures (IOP) were achieved with topical steroids, ganciclovir gel, and antiglaucoma medications. On a follow-up visit, he complained of recent onset of blurring of vision (OS) despite appropriate refractive correction, quiet anterior chamber, and normal IOP. Pupillary examination showed anisocoria (larger pupil in OS). Pupillary constriction (OS) on instillation of 0.125% pilocarpine drops confirmed the diagnosis of a tonic pupil.

Conclusion: We describe a unique finding of tonic pupil on a follow-up examination in an immunocompetent adult male with CMV anterior uveitis. A prior association has not been described in literature (Medline Search).

Keywords: Anisocoria; Posner–Schlossman syndrome; anterior uveitis; cytomegalovirus; tonic pupil.