Starry Eye

Published:November 06, 2022DOI:
      A 73-year-old woman with a past medical history of stroke, hypertension, and end-stage renal disease, on hemodialysis, presented to the Emergency Department for altered mental status and slurred speech. On physical examination, she had a right pupillary defect in a star-like pattern, with initial concern for a blown pupil (Figure), raising suspicion for acute stroke. Her initial blood pressure was 230/110 mm Hg, and neuroimaging was unremarkable for stroke. She was admitted for hypertensive emergency.
      FigureRight festooned pupil in the shape of a star due to multiple posterior synechiae.
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        • Kaiser P
        • Friedman N
        • Pineda R
        Iris and pupils.
        The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology. Saunders Elsevier, 4th ed. New York2014: 257-263 (4th ed)
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