Accessory Pupil in a 9-Year-Old Girl

A healthy 9-year-old girl was noted to have a hole in her left iris next to her pupil on routine examination. This color and infrared video shows synchronous movement of the hole during pupillary dilation and constriction, indicating it is a second or accessory pupil (polycoria) with an independent sphincter (arrowheads). The pupils are separated by a thin bridge of noncontractile tissue. A presumed mechanism for polycoria is a snaring or pinching off of the primary pupillary margin during development. Effects on vision depend on the size of the accessory pupil.