心因性瞳孔異常と思われる1症例

A case of presumed psychogenic pupillary disorder

　心因性によると思われる瞳孔の変動および不同と屈折異常を認めた16歳の1症例を報告した。

　瞳孔変化に加え，屈折において−4Dから−21Dまで，水晶体厚径においては1mm以上の変動がみられた。

　各種の点眼試験，X線・CT・MRI検査からは器質的疾患は否定的であった。

A 16-year-old girl manifested alternating anisocoria over the follow-up period of 3 years. Acute episodes of mydriasis or miosis developed following emotional stress. During episodes of mydriasis, the pupil reacted weakly to the light stimulus. Instillation of 2.5% mechoryl or 0.125% pilocarpine failed to induce miosis. During episodes of miosis, topical cocaine, tyramine or epinephrinefailed to induce mydriasis.

During episodes of miosis, the lens changed in thickness by more 1 mm within 4 hours. The refrac-tion changed from -4D to -21D without changes in ocular alignment. Repeated neuroradiological studies failed to detect organic lesions. We diagnosed the case as an exaggerated form of simple central anisocoria of presumed psychogenic origin.