Causes of anisocoria range from benign to life-threatening, making it a common reason for urgent Neuro-Ophthalmology referrals. The pathways controlling pupillary size and reactivity are complex and affected by lesions along this pathway or by systemic or topical agents.

Case series and review of literature.

1: A 15-year-old female had transient episodes of anisocoria and bilateral pupillary dilation. On exam, both pupils were mydriatic to 8.5 mm and nonreactive to light, without response to 1% pilocarpine eyedrops.

2: A 16-year-old female, referred for Adie tonic pupil, experienced a single episode of blurred vision, photophobia, and a dilated left pupil that lasted two days. She believed her symptoms were related to new contact lenses and had since worn her glasses without further recurrence.

3: A 38-year-old female noted three episodes of blurred vision accompanied by a dilated, nonreactive left pupil, lasting one to two days. Patient-provided photos showed a 4-mm right pupil and a fixed 7-mm left pupil.

The rest of the exam for all three patients was normal.

All three patients failed to list any medications that could explain their symptoms. Further questioning revealed the recent addition of an antiperspirant cloth wipe. Glycopyrronium (Qbrexza) cloth is an anticholinergic drug that received FDA approval in June 2018 for topical use to treat primary axillary hyperhidrosis.