Medicine:Diplocoria
Diplocoria is an ophthalmic term for the presence of two pupillary openings in a single iris ("double pupil"). In contemporary usage most reported "double pupils" represent pseudopolycoria: additional iris holes that lack their own sphincter muscle, whereas true diplocoria (a form of true polycoria) requires that each opening has a functional sphincter with synchronous constriction and dilation.[1][2] The term derives from Greek diplo- ("double") and korē ("pupil").[3]
Signs and symptoms
People with diplocoria or pseudopolycoria may experience glare, photophobia, ghosting, or monocular diplopia, due to multiple apertures disrupting the eye's optical system; reducing the effective pupil size can improve optical quality ("pinhole" effect).[4][5] In children, small reactive pupils and multiple apertures have been associated with intense miosis and amblyopia in case reports.[6]
Classification
Ophthalmic literature distinguishes:
- True diplocoria/true polycoria: each opening has a circumferential sphincter that reacts to light and pharmacologic agents; extremely rare.[1][7]
- Pseudopolycoria (false diplocoria): additional iris holes without sphincter muscle; these do not constrict independently and account for most "double pupil" appearances.[2]
Causes
True diplocoria is generally congenital and exceptionally uncommon. Apparent diplocoria is more often acquired pseudopolycoria from:
- iris procedures (e.g., surgical iridectomy/iridotomy, iris biopsy), trauma, or degeneration;[4]
- progressive iris atrophy in iridocorneal endothelial (ICE) syndrome, where tractional iris changes and stromal loss can produce iris holes (false pupils).[8][9]
Diagnosis
Slit-lamp examination documents the number, position, and shape of openings. In true diplocoria, both pupils constrict and dilate together to light or pharmacologic stimuli, indicating separate sphincters; in pseudopolycoria, only the primary pupil reacts.[1][2] Anterior-segment imaging and careful pharmacologic testing of the pupillary light reflex help differentiate true from false accessory pupils.[10]
Management
Treatment depends on symptoms and the underlying cause. Visual symptoms from pseudopolycoria may be reduced with prosthetic or tinted contact lenses that limit stray light or create a single functional aperture.[4] Selected cases of true diplocoria (true polycoria) have been treated surgically (e.g., pupilloplasty) to reconstruct a single round pupil.[11]
Epidemiology
Diplocoria in the strict, "true" sense is very rare and mainly documented in isolated case reports; most "double pupil" appearances are pseudopolycoria rather than true accessory pupils.[1][2]
See also
References
- ↑ 1.0 1.1 1.2 1.3 Islam, Niaz; Mehta, Jodhbir S.; Plant, Gordon T. (November 2007). "True polycoria or pseudo-polycoria?". Acta Ophthalmologica Scandinavica (Wiley) 85 (7): 805–806. doi:10.1111/j.1600-0420.2007.00985.x. PMID 17711542. https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-0420.2007.00985.x. Retrieved October 17, 2025.
- ↑ 2.0 2.1 2.2 2.3 Safi, A. (September 10, 2020). "Polycoria in a Young Girl". JAMA Ophthalmology (American Medical Association) 138 (9): e200656. doi:10.1001/jamaophthalmol.2020.0656. PMID 32910138. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2770662. Retrieved October 17, 2025.
- ↑ Venes, Donald (2025). "diplocoria". F. A. Davis Company. https://nursing.unboundmedicine.com/nursingcentral/view/Tabers-Dictionary/811336/all/diplocoria.
- ↑ 4.0 4.1 4.2 Sherman, Sarah W.; Khouri, Akrit S.; Campbell, Jeffrey P.; Say, Edwin A. T. (April 2021). "Relief of symptomatic pseudo-polycoria due to iris biopsy using a daily disposable prosthetic colored hydrogel lens". American Journal of Ophthalmology Case Reports (Elsevier) 22. doi:10.1016/j.ajoc.2021.101033. PMID 33898861.
- ↑ Manion, Garrett N. (February 28, 2024). "The Effect of Pupil Size on Visual Resolution - StatPearls". StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK603732/.
- ↑ Hofeldt, Gregory T.; Simon, John W. (October 2002). "Polycoria, Miosis, and Amblyopia". Journal of AAPOS (Elsevier) 6 (5): 328–329. doi:10.1067/mpa.2002.124649. PMID 12381993.
- ↑ Jaffe, Norman S.; Knie, Paul (1952). "True polycoria". American Journal of Ophthalmology (Elsevier) 35 (2): 253–255. doi:10.1016/0002-9394(52)90856-8. PMID 14903014. https://www.sciencedirect.com/science/article/abs/pii/0002939452908568. Retrieved October 17, 2025.
- ↑ Hollands, H. (September–October 2012). "Iridocorneal Endothelial Syndrome: Keys to Diagnosis and Management". BMJ USA/Glaucoma Today. https://glaucomatoday.com/articles/2012-sept-oct/iridocorneal-endothelial-syndrome-keys-to-diagnosis-and-management.
- ↑ Chandran, P. (2017). "Glaucoma associated with iridocorneal endothelial syndrome in Indian population". PLOS ONE (Public Library of Science) 12. doi:10.1371/journal.pone.0171884.
- ↑ Belliveau, Arden P. (October 24, 2023). "Pupillary Light Reflex - StatPearls". StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537180/.
- ↑ Bardak, Hüseyin; Ercalik, Neslihan Yalçın; Gunay, Mehmet; Bolac, R.; Bardak, Yusuf (November–December 2016). "Pupilloplasty in a patient with true polycoria: a case report". Arquivos Brasileiros de Oftalmologia (Sociedade Brasileira de Oftalmologia) 79 (6): 404–406. doi:10.5935/0004-2749.20160114. PMID 28099585.
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