A non-permanent tonic pupil in rheumatoid arteritis

A 76-year-old male with a severely deforming rheumatoid arthritis, eosinophilia, polymyositis, and episcleritis developed a transient tonic pupil. The episcleritis, and a muscle biopsy revealing an occlusive arteritis with eosinophilia, suggest that a wide-spread rheumatoid arteritis caused a reversible ischemic insult to the ciliary ganglion and thus created a transient denervation of the pupil.