A 15-year-old girl with variable anisocoria

On examination, her uncorrected near visual acuity was J1+ and her best-corrected visual acuity was 20/20 at distance and J1+ at near. Her glasses measured −4.50 +0.50 × 98 in the right eye and −4.75 D in the left eye. Ocular motility was full, and the pupils were equal, round, and reactive to light and accommodation. Her pupils measured 5 mm to 3 mm with direct pupillary light reflex and 5 mm to 2.5 mm to near stimulus. Her near point of convergence was approximately 4 cm from the nose, and her accommodative amplitude was assumed normal given her ease of accommodation and excellent near visual acuity through her full myopic correction. Slit-lamp examination demonstrated normal pupils without iris atrophy, sectoral palsy of the iris sphincter, or vermiform movements.