In this segment of the 2013 Neuro-Ophthalmology Subspecialty Day series on recognizing distinctive neuro-ophthalmic symptoms, signs, and tests, Rebecca Stacy presents to panelists Anthony Arnold, Lanning Kline, Mark Kupersmith, and Valerie Purvin the case of a 79-year-old woman presented for a routine eye exam. Her last eye exam was more than a year ago. During the exam, anisocoria was noted and she was referred for further evaluation. Neither the patient nor her family had noticed the anisocoria before it was pointed out to them, so the onset of the sign was uncertain. She denied any visual symptoms, headache, diplopia, neck pain, or dysguesia. She had no history of trauma or chiropractic manipulation. She was not a smoker.