Pupillary Miosis Without Ptosis

CLINICAL DIAGNOSTIC MANUAL

Pupillary miosis without ptosis is a condition where one or both pupils are abnormally constricted and do not dilate properly in low-light conditions, while the upper eyelid remains in its normal position.

This alteration can be caused by various conditions affecting the parasympathetic nervous system, the iris muscle, or the brainstem. Identifying the underlying cause is crucial, as some etiologies may require urgent medical intervention.

Condition	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Argyll Robertson pupil	Bilateral miosis, pupils do not respond to light but do accommodate, preserved pupillary reflexes	History of tertiary syphilis, associated neurological symptoms	Positive serology for syphilis, clinical history
Anisocoria	Difference in pupil size, one pupil may be miotic, not always pathological	Clinical history, physical examination	Neurological evaluation, exclusion of pathological causes
Age-related miosis	Small, non-reactive pupils, reduced pupillary response with age	History of aging	Clinical evaluation, exclusion of other causes
Drug-induced miosis	Bilateral miosis, history of opioid or cholinergic use, other systemic symptoms	History of drug exposure, systemic symptoms	Blood and urine tests detecting presence of drugs
Pontine haemorrhage	Bilateral miosis, altered consciousness, severe neurological signs	History of stroke or trauma	MRI or CT showing haemorrhage in the pons