Anisocoria

Unequal pupil size without associated features of the Horner syndrome (143000) or any other abnormality has been observed in a dominant pedigree pattern. We have observed one such family (P14104). Cheng and Catalano (1990) described uniocular, fatigue-induced mydriasis of the left pupil in a 36-year-old man and his 7-year-old daughter. The father dated the onset of his disorder to childhood, and it had been noted in his daughter for at least 2 years. Anisocoria consistently developed in both subjects after about 17 hours of wakefulness and resolved after about 2 hours of sleep. The father had a history of migraine headaches. The internal ophthalmoplegia that is occasionally seen in patients with ophthalmoplegic migraine typically follows or accompanies ocular or periocular pain. Furthermore, the paralysis usually lasts longer than 2 hours.