Politics - News Analysis Trump’s Pupils Are Often Very Dilated and a Doctor Explains What This Could Mean

Donald Trump is one weird dude, we know this.

One thing you may not have noticed though, is that Trump often has abnormally large pupils. And according to ophthalmologist Dr. Jack Brown, this is incredibly worrisome.

Or at Dr. Brown says, it’s “glaring. Sirens Blaring. Red flashing lights.”

Brown uses this photo of Trump to illustrate his concerns:

According to Brown, in that image Trump’s pupils are approximately 8.0 mm. The dark-adapted eyes of a healthy 12-year-old may have 8.0 mm pupils — but in an unmedicated 70-year-old with healthy eyes, in a well-lit room — the statistical odds of such large pupil size approaches zero.

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Why is this significant? Dilated pupils, to this degree, would not occur in a 70-year-old, in a well-lit room unless there is either disease, injury or a pharmacologic cause present. Trump’s pupils are frequently but intermittently this large (sometimes they are indeed within normal size limits).

Trump’s enlarged pupils are much less likely a sign of a significant undiagnosed or undisclosed medical condition — and much more likely, a side effect of a drug/medication (one of a relatively small group of drugs).

Brown states that Trump’s large pupils are most likely due to a medication.

Some of those medications include:

Amphetamines

Barbiturates

Cocaine

MDMA (Ecstasy)

Brown sums it up by stating:

President Donald Trump’s pupils are intermittently and significantly dilated — from a medical standpoint, this is NOT normal. The ambient light conditions cannot account for such changes. At other times they are within normal limits. This intermittent pattern is NOT due to trauma, complications from surgery, or disease. I have not examined Donald Trump and I have no firsthand knowledge of him — however, the myriad of photographic evidence available online seems to point strongly to the remaining possible etiology — Donald Trump’s Intermittently Dilated Pupils are due to the side effects of drugs/medications.

Twitter also was wondering why the president’s pupils always look like he’s on Adderall:

Brown also did a mega-thread on Twitter and systematically explains what’s going on:

1/ Why are Donald Trump's pupils intermittently so large? You probably haven't noticed, but President Trump's pupils are intermittently much larger than normal (the intermittent pattern is crucial). — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

2/ From a medical standpoint, this is not at all subtle or to be dismissed – on the contrary, it is glaring. Sirens Blaring. Red flashing lights. I write this article with the expertise of both an ophthalmologist as well as a body language expert. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

3/ In the image above Trump's pupils are approximately 8.0 mm. The dark-adapted eyes of a healthy 12-year-old may have 8.0 mm pupils – but in an unmedicated 70-year-old with healthy eyes, in a well-lit room – the statistical odds of such large pupil size approaches zero. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

4/ Why is this significant? Dilated pupils, to this degree, would not occur in a 70-year-old, in a well-lit room unless there is either disease, injury or a pharmacologic cause present. pic.twitter.com/5FNWntmAPt — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

5/ Trump's enlarged pupils are much less likely a sign of a significant undiagnosed or undisclosed medical condition – and much more likely, a side effect of a drug/medication (one of a relatively small group of drugs). — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

6/ Pupils react to both Light and Near Focusing – but also change with age Most people know that exposure to light causes the pupils to constrict. However, you may not know that focusing on an object close up (e.g., when reading) will also cause pupils to constrict. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

7/ These physiologic findings are normal for all healthy eyes. We cannot medically test for these stimuli (response to a bright light or response to focusing at near) on Donald Trump by evaluating available video or photos – … — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

8/ …however, at least with response to light, we can make some reasonable estimations. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

9/ You also may not realize that, under equal lighting conditions, pupils will become smaller with age. Thus an infant has much larger pupils than a 70-year-old. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

10/ This change, generally speaking, isn't very noticeable (for most casual observers) until a person reaches their 30s or 40s – and even then it's not dramatic. But certainly, this difference is much more noticeable in a 71-year-old. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

11/ Donald Trump's pupils are very frequently larger (often much larger) than they should be for healthy eyes of his age. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

12/ His pupils are sometimes as almost as large as they would be if they were medically dilated by an ophthalmologist (with eye drops, such as Tropicamide and Phenylephrine). — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

13/ As a control, we can compare Trump's pupils to those who have interviewed him, and are under the same light conditions. In the images immediately above and below, we see Donald Trump and Tucker Carlson during a 15 March 2017 interview. pic.twitter.com/ERgqy5aKHe — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

14/ Trump's pupils are approximately 5.0 mm in diameter while Carlson's are 3.0 mm. Carlson is 23 years younger than Trump, thus all other things being equal, Carlson's pupils under equal light conditions should be larger – not equal, let alone smaller – than Trump's pupils. pic.twitter.com/imRZIFIzYo — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

15/ Are Donald Trump's Large Pupils a complication Cataract Surgery?

This is highly doubtful — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

16/ Cataracts are an entirely normal aging process. Virtually all 71-year-old people have at least mild evidence of cataracts (and certainly they may be moderate or advanced) and thus many will have cataract development to a degree for which surgery is indicated. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

17/ And while it's not entirely clear if Trump has had cataract surgery, some of the available images online are physically close and with high enough resolution to suggest this is the case. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

18/ For several decades it's been considered at least a mild-to-moderate surgical complication to have a permanently dilated pupil (or partially/permanently/poorly reactive pupil) after cataract surgery. This complication can be thought of as a form of micro-trauma to the iris. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

19/ Such findings are often a signal that other complications also occurred during surgery. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

20/ While even in the best surgeon's hands, complications do occur, the likelihood that Trump had this complication in both eyes, is extremely unlikely – because each pupil constricts and contracts – a healthy quality. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

21/ Large pupils after cataract surgery often cause a lot of unwanted symptoms (e.g., glare, reflection, increased astigmatic effect, photophobia, etc.). It's possible that Trump has some of these symptoms, but probably not to any significant degree. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

22/ Indeed, if the iris is damaged – leaving large pupils after cataract surgery, often a secondary procedure is performed to make the pupil smaller – thus minimizing any of the above-mention symptoms. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

23/ Trump's pupils are equal (or very closely so). And although they are often larger than normal, they do vary in size and are at times "within normal limits". — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

24/ This finding eliminates surgical complications as a cause of Trump's often larger pupil size. Pupils damaged as a result of surgery wouldn't respond in this manner. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

25/ In this image, his pupils are 3.5 – 4.0 mm (the slight difference in his pupil size [known as physiologic Anisocoria] is not significant or medically noteworthy – although certainly if one pupil was much larger or much smaller, it would be very important). pic.twitter.com/4cTF3w9hA3 — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

26/ So here we see that his pupils ARE indeed ABLE to contract to a smaller size – and this is crucial. But the question is – why are they intermittently so large, so often? — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

27/ Are Trump's large pupils due to him deliberate dilating his own pupils with eye drops? This is highly doubtful. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

28/ Medications such as Atropine, Scopolamine, Phenylephrine, Tropicamide, Homatropine, and Cyclopentolate are used to dilate pupils for ophthalmic examinations. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

29/ These are also used to treat certain medical conditions in the eyes. Most notably these include various inflammatory conditions (Iritis, Uveitis, etc.). — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

30/ These conditions will often be correlated with diseases which frequently have serious ramifications for other parts of the body (thus may represent ophthalmic manifestations of systemic diseases). — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

31/ Occasionally, people will deliberately dilate their pupils so as to feign a medical condition & thus seek attention (Munchausen syndrome). This is extremely unlikely in the case of President Trump's pupils – for he always tries to present himself as extremely healthy. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

32/ There are even species of plants, which, upon gardening and then rubbing one's eye will have this effect. When this occurs, it will almost always effect only one eye – not both. Again, a long-term observation of Trump's eyes negates this possibility. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

33/ Are Trump's large pupils due to Trauma? Highly Doubtful — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

34/ What about trauma? Could eye or head trauma cause a person's pupils to be large? Yes – but not in Trump's case. Since Donald Trump's pupils change in size over time, and they are round (not irregular in shape) and equal in size – trauma can be eliminated as a cause. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

35/ What about a Disease or other Medical Condition? — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

36/ Below is a list of medical causes of Enlarged Pupils, none of which applies in Trump's case, for multiple reasons, but in particular because his pupil size changes over time and also would have multiple other associated symptoms with any of these conditions. pic.twitter.com/MQfkB8Y3bw — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

37/

Adie's Pupils, bilateral

Botulism

Cardiac Arrest

Cranial Nerve III (Oculomotor nerves), partial and bilateral,

Diabetes Mellitus

Diphtheria

Encephalitis

Guillain–Barré syndrome

Hypermagnesemia

Hypothermia

Increased Intracranial Pressure

… — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

38/

Iris scaring (synechia) secondary to injury or inflammatory disease (Iritis/Uveitis)

Multiple Sclerosis (MS)

Sarcoidosis

Sylvian Aqueduct Syndrome

Syphilis (Neurosyphilis)

… — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

39/

Tumors/space occupying lesions

Venom from various poisonous animals (certain snakes, spiders, octopi, and fish)

Wernicke–Korsakoff syndrome — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

40/ What about Medications/Drugs as a Cause of Trump's Large Pupils? This cause is HIGHLY LIKELY pic.twitter.com/ntKO3pFx2e — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

41/ Are Trump's large pupils caused by Systemic Drugs? (medications not used in eye drops [as mentioned above], but taken by mouth or by other means) – From a medical standpoint, this is highly probable. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

42/ Here's a of list of the possibilities (of course, anesthesia and those labeled with "poisoning" and "overdose" don't apply): 5-HT2A receptor-mediated psychedelic drugs

5-Hydroxytryptophan

Adrenaline

Amphetamine

… — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

43/

Anesthesia (deep general anesthesia or near-total spinal anesthesia)

Antidepressants such as (such as TCAs [overdosage], SSRIs, SNRIs, and MAOIs)

Antihistamine overdose

Barbiturates

Bretylium intoxication

Chlorphentermine

Cocaine

Cyanide poisoning

Dopamine

Ephedrine

… — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

44/

Fenfluramine

Glutathimide overdose

Methanol poisoning

MDMA (Ecstasy)

Noradrenaline

Propranolol overdose

Quinine toxicity

Trimethaphan

Tryptophan overdose — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

45/ Summary: President Donald Trump's pupils are intermittently and significantly dilated – from a medical standpoint, this is NOT normal. The ambient light conditions cannot account for such changes. At other times they are within normal limits. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

46/ This intermittent pattern is NOT due to trauma, complications from surgery, or disease. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

47/ I have not examined Donald Trump and I have no firsthand knowledge of him – however, the myriad of photographic evidence available online seems to point strongly to the remaining possible etiology – … — Dr. Jack Brown (@DrGJackBrown) March 2, 2018

48/ …Donald Trump's Intermittently Dilated Pupils are due to the side effects of drugs/medications. Recent reports by journalist Kurt Eichenwald are consistent with this conclusion. — Dr. Jack Brown (@DrGJackBrown) March 2, 2018