Challenging equality of pupils: A case series of anisocoria during a current epidemic of viral conjunctivitis in India

To report three cases of anisocoria during a current epidemic of conjunctivitis in India. Three healthy patients presented with bilateral red eyes amid the eye flu epidemic in India, with associated photophobia. On examination, they were detected to have anisocoria. The first case was found to have Holme’s Adie syndrome with Adie’s tonic pupil and absent deep tendon reflexes. The other two cases had anisocoria, but the light reaction was present in the affected pupil. Pharmacological testing with diluted 0.1% pilocarpine resulted in constriction of the larger pupil with no change in the normal pupil in all the three cases. Pupillography was utilized as a key tool to substantiate our findings. In all the three patients, the anisocoria decreased with the resolution of the conjunctivitis which reinforces the possible association. This case series highlights the importance of meticulous ocular examination even during an epidemic of eye flu, which would prevent prejudice of any preexisting or coexisting ocular findings.