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Dilated Pupil Update

My sister’s 1 year old baby had a sudden dilated pupil in only one eye, confirmed by two witnesses and lasting several minutes. I blogged about the event here, and have been quite perplexed ever since. Unequal pupils are fairly rare and don’t have all that many potential causes – some of which are life threatening (shhh).

As with many patient histories, the devil’s in the details. Although I asked my sister if there was any possible way that her baby could have gotten a strange chemical in her eye (and she assured me that nothing of the kind could have happened) my mom outed her to me via phone.

“Oh yes, they had their floors resurfaced the day prior [to the pupillary event,] and the babies were crawling all over that new floor.”

Hmm… so there WAS a potential chemical exposure after all. “Ah hah!” I thought. So I decided to do a Medline search for cases of chemical exposures causing anisocoria (pupils of different sizes). I soon realized that I’d forgotten to constrain my search to human studies, but was most amused by some factoids that I turned up.

My favorite study title was this:

“Anisocoria in the dog provoked by a toxic contact with an ornamental plant.” Surely the ornamentality of the plant is irrelevant to its toxic properties? What sort of provocation could the plant have inspired in this innocent canine? Well, it was a French study – perhaps something was lost in translation.

The runner up is this one:

“Clinical and necropsy findings associated with increased mortality among American alligators of Lake Griffin, Florida.” Apparently, different pupil sizes don’t bode well for alligator longevity, especially in Lake Griffin, Florida. Note to self – if I’m about to be attacked by an alligator, look him straight in the eye to find out if he has a chance of winning.

Honorable mention goes to:

“Liberalized screening for blunt carotid and vertebral artery injuries is justified.” Which tells me that some folks may not even notice or recall a blunt force injury to the neck – so we should be on the lookout and ready to screen people liberally for this concerning and under recognized issue.

Sigh. Did I find anything helpful about floor refinishing chemicals and potential eye effects? Nope. My attention drifted off at around study number 300 (I had gone back 10 years in the literature). Though I have to say that many journal article titles are inherently whimsical. So my dear readers – I open the question to you all: Have you ever heard of a floor finishing chemical causing a pupil to dilate?

Come on, I’m dangling a nice case report out here for you…

(And yes, we’ll keep an eye on the baby for any signs of a more ominous cause, stay tuned).

This post originally appeared on Dr. Val’s blog at

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4 Responses to “Dilated Pupil Update”

  1. RH Host Meredith says:

    Thanks for keeping us updated, Val.  Your niece has been in my thoughts.

  2. anonymous says:

    Hi Val , did you go for the tradename of the refinisher ?

  3. StacyBStryerMD says:

    Val, I’m curious about your niece.  How is she doing?  Any recurrence of the dilated pupil or other problems?

  4. RH Host Meredith says:

    Hi Dr. Val!  Just wondering how your niece is doing?

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