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The pupils are normally equal, round and equally reactive to light and near. In some conditions the pupils become abnormally shaped or exhibit unusual behavior.(Table) A tadpole pupil is one that intermittently and briefly becomes elongated and comma-shaped because of spasm involving one sector of the pupillodilator.(1-3) It is a benign condition.
[http://jamanetwork.com/journals/jamaneurology/article-abstract/2604129 Aggarwal and Hildebrand] published an example of a tadpole pupil online in JAMA Neurology February 20, 2017.(4) The patient was a 2-year-old girl who presented with episodes in which the right pupil became oval. The tadpole pupil would begin to improve after 10 minutes and completely resolved resolve after 40 minutes. She was otherwise well and had no other neurological symptoms. MRI excluded any pathology. ==References==1. Campbell WW. Clinical signs in neurology: a compendium. Philadelphia: Wolters Kluwer Health, 2016.2. Kawasaki A, Mayer C. Tadpole pupil. Neurology 2012;79:9493. Thompson HS, Zackon DH, Czarnecki JS. Tadpole-shaped pupils caused bysegmental spasm of the iris dilator muscle. Am J Ophthalmol. 1983;96:467-774. Aggarwal K, Hildebrand GD. The Tadpole Pupil. JAMA Neurol. Published online February 20, 2017. doi:10.1001/jamaneurol.2016.5981 [[Category: Neuro-ophthalmology]]
Table. Some of the unusual pupillary shapes, reactions and behaviors that occasionally occur.