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 results in decreased function of iris and pupil, affecting the physical eye and visualization. In the early history of China, double pupils were seen as a sign that a child would become a great king or sage. Epidemiology
Polycoria is extremely rare, and other conditions are frequently mistaken for it. Polycoria is often congenital, however not diagnosed until adulthood. The general cause of polycoria is unknown, but there are some other eye conditions that are in association with polycoria. These include (although not often) polar cataracts, glaucoma, abnormally long eyelashes, abnormal eye development, and poor vision.There have been cases diagnosed from age 3 to adulthood. The prevalence of true polycoria is minimal. The two kinds of polycoria are true polycoria and false pseudopolycoria. There are no known or proposed trends in the occurrences of polycoria based on geographical location, age, gender, or season. True polycoria
In cases of true polycoria, there is an extra pupil that tends to be reactive to light and medication. To be considered true polycoria the extra pupil and the principal pupil must dilate and contract simultaneously with triggers such as light and administered drugs. The extraneous pupil is c. 2.5mm away from the principal pupil. In cases of true polycoria there is an intact sphincter muscle, which contracts and dilates the pupils.
A 1-mm limbal incisions would be made, a spatula is inserted through the side to elevate the two pupils (avoiding contact with the lens), and the iris tissue would be cut using viscoelastic material. Finally, the limbal incisions were closed with stromal hydration, and intracameral cefuroxime is applied. Surgical technique
There have been cases where there are various techniques for surgical procedures and can be performed on children and adults. One of the techniques for repair is by using a double armed polypropylene suture, where the suture is left externally on the sclera with a knot buried in the scleral flap. This technique allows posterior fixation of intraocular lens implants in the absence of capsular support. Another technique for surgery is called pupilloplasty, where the patient would be placed under retrobulbar anesthesia with the pupils being dilated with 1% tropicamide. Prognosis
Postoperative care
Hypertonic saline solution used as eye drops may be used to reduce the corneal edema, the use of anti-glaucomatous topicals to help improve corneal edema, and aqueous suppressants that are accompanied by miotics, include topical beta blockers, alpha antagonists, and carbonic anhydrase inhibitors. Antibiotics and steroid drops for 4 weeks post surgery. Complications and benefits
Complications of surgical procedures are possible suture erosion through the sclera, conjunctiva, or both. Minor intraocular inflammation during and after surgery. Improved distant and near visual acuity, little defects surrounding sphincter muscles, and normal pupillary margins. Prevention
There are no known preventive measures for polycoria, however genetic testing may be able to reveal genetic patterns of the disorder.