Pupillary Mydriasis Without Ptosis

CLINICAL DIAGNOSTIC MANUAL

Pupillary mydriasis without ptosis is a condition where one or both pupils are abnormally dilated and do not respond appropriately to changes in light, while the upper eyelid maintains its normal position.

This alteration can indicate several disorders affecting the autonomic nervous system, the iris muscle, or the brainstem. Accurate and prompt evaluation of the underlying cause is crucial, as some etiologies can be life-threatening or require immediate intervention.

Condition	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Holmes-Adie pupil	Unilateral mydriasis, slow response to light, better reaction to accommodation, decreased tendon reflexes	History of pupillary changes without significant neurological symptoms	Pilocarpine test showing response in the dilated pupil
Traumatic iridoplegia	Persistent dilated pupil, history of ocular trauma, blurred vision, photophobia	Recent history of ocular trauma	Ophthalmologic exam showing structural iris damage
Drug-induced mydriasis	Bilateral mydriasis, history of drug use or exposure to toxic substances, other systemic symptoms	History of exposure to sympathomimetic agents (cocaine, amphetamines)	Blood and urine tests detecting toxic substances
Severe brainstem injury	Bilateral mydriasis, altered consciousness, severe neurological signs	History of traumatic brain injury, stroke, or brain herniation	MRI or CT showing brainstem lesions
Death	Fixed bilateral mydriasis, absence of pupillary response, apnea, lack of cardiac activity	Absence of vital signs and neurological reflexes	Clinical confirmation of brain death by clinical criteria and additional tests