# Bizarre pupil



## Seaglass (Nov 18, 2009)

I've been meaning to ask this, and one of the scenarios just reminded me. What could cause a patient to develop an oblong pupil with an irregular border? I saw this on a stroke call recently. The family didn't speak much English, but they seemed to be telling us that it wasn't normal for the patient.


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## akflightmedic (Nov 18, 2009)

Cataracts, cataract surgery...quick response I am sure there are more reasons.


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## Lifeguards For Life (Nov 18, 2009)

Are you asking about a blown pupil?

Aniscoria(unequal pupils) is estimated to occur normally in about twenty percent of the population.

Contusion of the oculomotor nerve causes a dilated  pupil. The patient will also have ptosis and adduction paresis, causing lateral deviation of the eye due to unopposed cranial nerve IV.

Any injury to the midbrain may cause loss of pupillary response, irregularly shaped pupils, or asymmetric pupil size.

Sometimes in people who are near sighted, iris can lose its pigment as it rubs on the lens and its zonules, called pigment dispersion. This can cause pupil irregularities that are only noticed at certain times and may be subtle. 

A number of pathophysiologies and congenital defects in the ciliary muscles can also cause asymetrical pupils.


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## HuiNeng (Nov 18, 2009)

*feline iris abnormality*

Viral infection in cats can cause a wavy iris. My tomcat has one iris that won't close properly. The edges of the iris are buckled. Don't know if humans have similar viral infections.


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## Seaglass (Nov 18, 2009)

Thanks, everyone!

I'd only call it blown for lack of a better word. For lack of a better comparison, it was shaped like a football or goat's pupil, and only a bit larger than I'd expect for the room lighting. It wasn't perfectly centered. None of these were subtle at all. The other pupil was pinpoint and regular, and both were fixed. He was in pretty bad shape overall, so we noted the pupil abnormality but focused on the more concerning symptoms. Given that it was a stroke call, weird pupils weren't really out of place--it was more the type and degree of weirdness that made me wonder about the mechanism.


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## Hal9000 (Nov 18, 2009)

Seaglass said:


> Thanks, everyone!
> 
> I'd only call it blown for lack of a better word. For lack of a better comparison, it was shaped like a football or goat's pupil, and only a bit larger than I'd expect for the room lighting. It wasn't perfectly centered. None of these were subtle at all. The other pupil was pinpoint and regular, and both were fixed. He was in pretty bad shape overall, so we noted the pupil abnormality but focused on the more concerning symptoms. Given that it was a stroke call, weird pupils weren't really out of place--it was more the type and degree of weirdness that made me wonder about the mechanism.



I once cut my eye open, and it started "leaking out" for lack of a better phrase.  This process quickly caused it to become shaped like a domestic cat's pupil.  Thankfully, some quick emergency work and a month of recovery fixed everything, and I still have 20/20.  Kinda freaky, but it didn't hurt, which is odd to me.


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## usafmedic45 (Nov 18, 2009)

I was about to say severe pressure derangements or trauma/surgery can cause the pupil to change shape.  I've only seen it a couple of times in live victims to be quite honest. 



> Kinda freaky, but it didn't hurt, which is odd to me.



That's because the eyeball itself (at least the forward part) lacks significant pain receptors.  The brain is similar in this respect.


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## Hal9000 (Nov 18, 2009)

usafmedic45 said:


> That's because the eyeball itself (at least the forward part) lacks significant pain receptors.  The brain is similar in this respect.



I don't recall covering pain response in the eye in college, which is odd now that I think about it.  I know that corneal abrasions can cause a lot of pain, but I don't remember any from this episode.  A piece of plastic popped off and hit me from a new item I had purchased, and if landed almost directly over my pupil.  It cut the cornea right open and the iris prolapsed.

Seeing this in person is very interesting, but I imagine also somewhat rare.


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## Seaglass (Nov 18, 2009)

I can't say I remember pain in the eye ever being covered in college, either. Interesting subject. Will need to look it up.

From what we could get out of the family, it sounded like he'd been alone for awhile before anyone realized his condition. I suppose he could've injured it during that time, although it seems like a bit of a stretch. 



Hal9000 said:


> This process quickly caused it to become shaped like a domestic cat's pupil.



You fixed it, when anime geeks and goths alike would kill to naturally look like that?


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## RyanMidd (Nov 19, 2009)

I have to admit that when I saw the name of this thread, I thought it was going to be about the quirks of a weird classmate of yours.


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## Lifeguards For Life (Nov 19, 2009)

RyanMidd said:


> I have to admit that when I saw the name of this thread, I thought it was going to be about the quirks of a weird classmate of yours.



haha i think theres a thread in here dedicated to odd classmates/coworkers. i


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## Hal9000 (Nov 19, 2009)

Seaglass said:


> You fixed it, when anime geeks and goths alike would kill to naturally look like that?



  There are enough people in this world to freak me out.  I don't need to be another one of them.


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## LucidResq (Dec 9, 2009)

If it is normal for the patient, it could be a benign congenital abnormality known as a coloboma.


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## EMT007 (Dec 10, 2009)

...


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## Seaglass (Dec 10, 2009)

LucidResq said:


> If it is normal for the patient, it could be a benign congenital abnormality known as a coloboma.



Thanks! Just looked that up. Could've been... the family seemed to indicate otherwise, but we had some language issues there, so who knows.


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