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 [1].”
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.
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 [1] 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]
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]
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]
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 [5]
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [6]
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 [7]
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 [8]
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 [9]
8/ …however, at least with response to light, we can make some reasonable estimations.
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [10]
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 [11]
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 [12]
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 [13]
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 [14]
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 [15]
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [16]
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 [17]
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [18]
15/ Are Donald Trump's Large Pupils a complication Cataract Surgery?
This is highly doubtful— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [19]
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 [20]
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 [21]
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 [22]
19/ Such findings are often a signal that other complications also occurred during surgery.
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [23]
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 [24]
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 [25]
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 [26]
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 [27]
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 [28]
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 [29]
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [30]
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 [31]
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 [32]
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 [33]
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 [34]
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 [35]
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 [36]
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 [37]
33/ Are Trump's large pupils due to Trauma?
Highly Doubtful
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [38]
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 [39]
35/ What about a Disease or other Medical Condition?
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [40]
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 [41]
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [42]
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 [43]
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 [44]
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 [45]
40/ What about Medications/Drugs as a Cause of Trump's Large Pupils?
This cause is HIGHLY LIKELY pic.twitter.com/ntKO3pFx2e [46]
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [47]
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 [48]
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 [49]
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 [50]
44/
Fenfluramine
Glutathimide overdose
Methanol poisoning
MDMA (Ecstasy)
Noradrenaline
Propranolol overdose
Quinine toxicity
Trimethaphan
Tryptophan overdose— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [51]
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 [52]
46/ This intermittent pattern is NOT due to trauma, complications from surgery, or disease.
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [53]
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 [54]
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 [55]
49/ I invite everyone to refute or confirm these medical findings – particularly those physicians with neuro-ophthalmology expertise.
I also suggest that an independent party set up a publically available photo/video diary of President Trump's pupils.
END
— Dr. Jack Brown (@DrGJackBrown) March 2, 2018 [56]