Anisocoria Following Uncomplicated Cataract Surgery

In this report, we describe a case of anisocoria following uncomplicated cataract surgery. Clinicians should consider postoperative mechanical and tonic pupils when evaluating patients with anisocoria.

A 69-year-old White female underwent uncomplicated cataract surgery of her left eye. No intraoperative pupil expansion devices were used, and no floppy iris or iris prolapse occurred during the surgery. Postoperatively, she was found to have anisocoria. Pharmacologic pupillary testing confirmed a tonic and mechanical left pupil.

There have been no reported causes of anisocoria from a tonic pupil after cataract surgery. Based on reports of tonic pupils following other eye surgeries, our case likely occurred from a combination of parasympathetic dysfunction and mechanical trauma.

To our knowledge, this is the first report of a tonic pupil following cataract surgery, thus expanding the literature of causes of anisocoria that may be underrecognized in the clinical setting.