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The pupillary reflex is a complex physiological response involving both the eye and associated neural pathways. Relative afferent pupillary defects (RAPDs) can present due to various underlying pathologies, yet their occurrence in serotonin syndrome has been rarely documented. This report details the case of a 21-year-old non-binary individual with a history of bipolar disorder who presented to the emergency department following a polypharmacy overdose, including significant ingestion of sertraline, aripiprazole, and buspirone.

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Background: Abnormal pupillary reactivity is a neurological emergency requiring prompt evaluation to identify its underlying causes. Although isolated unilateral mydriasis without accompanying neurological abnormalities is rare, it has occasionally been associated with nebulizer use. We aimed to quantitatively assess pupillary changes using a pupillometer in cases of isolated mydriasis, which has not been described in previous studies.

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