Internal ophthalmoplegia means involvement limited to the pupillary sphincter and ciliary muscle. Other symptoms include dilated pupils and decreased pupillary light reflex. Physostigmine also has a miotic function, causing pupillary constriction. Observing pupillary constriction should also be indicative of accommodation. Reported symptoms include anorexia, refusal to drink, vomiting, pupillary dilation, and muscle paralysis. Improved distant and near visual acuity, little defects surrounding sphincter muscles, and normal pupillary margins. She also displayed minor symptoms&colon; pupillary dilation, hiccups, and lacrimation. This indicates an intact direct and consensual pupillary light reflex. The patient may be examined with pupillary dilation and education given prior to the procedure. Involved in circadian rhythms, pupillary reflex, and color correction in high-brightness situations. The pupillary light reflex is mediated by the pretectum. Beside circadian / behavioral functions, ipRGCs have a role in initiating the pupillary light reflex. It is important in the bilateral pupillary light reflex. This shows that the pupillary light reflex is modulated by visual awareness. Occasionally, a peripheral iridectomy may be performed to minimize the risk of pupillary block glaucoma.