Your examination of a patient reveals bilateral dilated pupils with absent reaction to light and accommodation. These findings most likely indicate which of the following?
a. anisocoria caused by disturbance of the neurophthalmic pathways
b. Argyll Robertson pupils caused by encephalitis or brain tumor
c. increased intracranial pressure from severe head trauma
d. the effects of topical application of miotic drops
C
Increased intracranial pressure from severe head trauma, brainstem infarction, and cardiopulmonary arrest are the likely pathologies when both pupils are dilated and fixed and do not react to light or show accommodation. Anisocoria caused by disturbance of the neurophthalmic pathways is characterized by unequal pupil size, but both pupils react to light and accommodation. Argyll Robertson pupils are bilaterally small and irregularly shaped. They both react to accommodation, but sluggishly or not at all to light. Constricted and fixed pupils are called miosis and can occur with the use of miotic drops for glaucoma treatment.
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