Polycoria

Polycoria

Definitions:-

Polycoria is a pathological condition of the eye characterized by more than one pupillary opening in the iris. It may be congenital or result from a disease affecting the iris. It may be divided as True polycoria and Pseudopolycoria. In the case of true polycoria, the other iris openings are also covered by sphincter papillae muscle.

True Polycoria is extremely rare, and other conditions are frequently mistaken for it.

Causes:-

This condition may be produced by hypoplasia or hyperplasia of the iris stroma or by surgical or accidental trauma. Depending upon the location of the extra pupil, vision may be affected May be caused by the division of the normal pupil into two by a band of the persistent pupillary membrane, or it may be from openings in other parts of the iris. Only the central or true pupil is furnished with a sphincter muscle. Iris holes occur with considerable frequency, but in the great majority of cases, they represent colobomata, iris dehiscence or iris diastasis. They are simple defects in the iris, have no pupillary sphincter and are not true pupils (Duke-Elder 1964).

 Pseudopolycoria is distinguished by the passive constriction of the accessory pupil when the true pupil is dilated.

Diseases like Axenfeld-Rieger syndrome (ARS), Iridocorneal Endothelial Syndrome (ICE) syndrome may be associated with polycoria.

Differential diagnosis of polycoria:-

a) Iris coloboma

b) Mole in the iris (mole can be differentiated from polycoria by retroillumination test or by distant direct ophthalmoscopy. In case of polycoria red fundal reflex will be visible)

c) Iridoschisis.

Signs and symptoms:-

The patient will complain of seeing multiple images (diplopia or polyopia) and Glare, reduced visual acuity. It may be monocular or binocular... On slit-lamp examination, multiple pupils and its cause may be evident. Congenital polycoria may give rise to amblyopia due to reduced vision and may be associated with refractive errors.

Management:-

If it is uniocular then patching of the affected eye may solve the problem. Prosthetic Contact lenses may be used.

Correction of refractive errors if any should be done and therapy for amblyopia in case of congenital one.

If it is associated with congenital syndromes, then that should be treated accordingly

If it is due to injury in the iris, then the surgical repair may be tried.