This patient was seen at age 48 years with very small pupils. She had been born with pinpoint pupils. The pupils were unresponsive to dilation. She complained of worsening visual acuity. Evaluation was challenging because of her microcoria. After discussion with the patient we proceeded to perform a pupil stretching and sphincterotomy. Subsequently the patient’s lens was removed and her visual acuity in this eye improved from 20/70 to 20/20. Ultimately the fellow eye was also done. Congenital microcoria is rare and often associated with angle abnormalities, as was the case in this patient. By definition the pupil is less than 2 mm in diameter and nonreactive or minimally reactive. The patients may have minimal symptoms other than difficulty negotiating dark environments. Microcoria may be sporadic and, when seen as an inherited disorder, is typically autosomal dominant.