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Tonic pupil and orbital glial-neural hamartoma in infancy
A R Brooks-Kayal1, G T Liu, S J Menacker
1Neurology Service, University of Pennsylvania School of Medicine, USA.
Insights
A rare tonic pupil in an infant was linked to a benign orbital mass. This finding highlights the importance of investigating the cause of abnormal pupillary responses in early childhood.
Area of Science:
- Ophthalmology
- Pediatric Neurology
- Neuro-oncology
Background:
- Tonic pupils, characterized by a delayed and sustained pupillary constriction, are uncommon in early childhood.
- Investigating the etiology of pupillary abnormalities in infants is crucial for timely diagnosis and management.
Observation:
- A 3.5-month-old infant presented with a poorly reactive right pupil, lacking other signs of oculomotor nerve palsy.
- Ocular examination revealed no strabismus or proptosis.
Findings:
- Pharmacological testing with 0.125% pilocarpine confirmed denervation hypersensitivity, indicative of a tonic pupil.
- Magnetic resonance imaging (MRI) identified a right orbital mass compressing ocular muscles.
- Histopathological analysis of the mass revealed a benign glial-neural hamartoma.
Implications:
- This case suggests a potential association between benign orbital masses and tonic pupils in infants.
- Early identification and characterization of orbital masses are essential for managing pediatric pupillary abnormalities.
- Further research may elucidate the mechanisms linking orbital tumors to autonomic nervous system dysfunction in the pediatric population.
Purpose/Methods:
Tonic pupils in early childhood are rare. We studied an otherwise healthy 31/2-month-old girl who had a right pupil that was poorly reactive to light, without other signs of oculomotor nerve palsy.
Results/Conclusions:
Constriction of the right pupil after instillation of 0.125% pilocarpine eyedrops confirmed denervation hypersensitivity, consistent with a tonic pupil. There was no strabismus or proptosis. A magnetic resonance imaging scan demonstrated a right orbital mass, interposed between the lateral and inferior recti muscles. Biopsy was consistent with a benign, glial-neural hamartoma. Thus, in this young patient, a tonic pupil was associated with a benign orbital mass.