Bitemporal palsy of the pupillary sphincters. A sign of diffuse circulatory insufficiency

Two patients with generalized arteriosclerotic changes presented with oval-shaped pupils in both eyes. Sectorial palsy of the iris sphincters, essentially in the lower temporal segments, was demonstrated. Paralyzed sectors did not react to 2% pilocarpine. There was no dilator weakness, and the iris did not exhibit atrophy or synechia. We consider the sectorial palsy of the sphincters in these patients to be due to circulatory insufficiency of the iris. We reviewed previously published cases of diffuse or multifocal circulatory insufficiency with ischemic iris changes, and analyzed the accompanying photographs. We found that temporal segments of the iris are predominantly involved in these patients. Predisposition to this sectorial palsy, especially in the pupillary temporal region, might be explained by several anatomical particularities of the vascular network in the iris. Bitemporal palsy of the pupillary sphincters may be a sign of generalized circulatory insufficiency.