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Benign Episodic Unilateral Mydriasis in a Flight Nurse
Aerospace Medicine and Human Performance
|April 19, 2017
Summary
Benign episodic unilateral mydriasis, a condition causing unequal pupil size, can occur in flight personnel. Rapidly resolving cases in austere environments may not warrant removal from flight status if diagnosed confidently.
Area of Science:
- Ophthalmology
- Aerospace Medicine
- Neurology
Background:
- Anisocoria, or unequal pupil size, can stem from benign episodic unilateral mydriasis, potentially linked to autonomic nervous system imbalances.
- While associated with migraines, asymptomatic cases exist, posing diagnostic challenges in excluding serious neurological conditions.
- Flight environments introduce unique factors like variable light and night vision device use, complicating assessments.
Observation:
- A 27-year-old female flight nurse deployed in Afghanistan presented with acute right-sided mydriasis.
- The patient reported no headache or migraine history; examination revealed a dilated, reactive right pupil that resolved spontaneously.
- An ophthalmologist confirmed the diagnosis of benign episodic unilateral mydriasis.
Findings:
- Benign episodic unilateral mydriasis can present acutely and resolve rapidly.
- A comprehensive history and physical examination are crucial for accurate diagnosis.
- Prompt diagnosis in deployed settings can prevent unnecessary, resource-intensive investigations.
Implications:
- Accurate diagnosis of benign episodic unilateral mydriasis is vital for operational readiness in military aviation.
- Rapidly resolving cases, like the one observed, may not necessitate grounding flight personnel.
- Clinical judgment regarding patient care capability and diagnosis is paramount in austere operational settings.