Ĭauses of anisocoria range from benign (normal) to life-threatening conditions.Ĭlinically, it is important to establish whether anisocoria is more apparent in dim or bright light to clarify if the larger pupil or smaller pupil is the abnormal one. Alkaloids present in plants of the genera Brugmansia and Datura, such as scopolamine, may also induce anisocoria. Some examples of pharmacological agents which may affect the pupils include pilocarpine, cocaine, tropicamide, MDMA, dextromethorphan, and ergolines. Pharmacological agents with anticholinergic or sympathomimetic properties will cause anisocoria, particularly if instilled in one eye.In ischemic lesions of the oculomotor nerve, pupillary function is usually spared whereas in compressive lesions the pupil is involved. Oculomotor nerve palsy: Ischemia, intracranial aneurysm, demyelinating diseases (e.g., multiple sclerosis), head trauma, and brain tumors are the most common causes of oculomotor nerve palsy in adults.Tonic pupil is characterized by delayed dilation of iris especially after near stimulus, segmental iris constriction, and sensitivity of pupil to a weak solution of pilocarpine. It may be associated with loss of deep tendon reflex (Adie's syndrome). Adie tonic pupil: Tonic pupil is usually an isolated benign entity, presenting in young women.Mechanical anisocoria: Occasionally previous trauma, eye surgery, or inflammation ( uveitis, angle closure glaucoma) can lead to adhesions between the iris and the lens.In this condition, the difference between pupils is usually less than 1 mm. Physiological anisocoria: About 20% of population has a slight difference in pupil size which is known as physiological anisocoria.For physiologic anisocoria, no treatment is needed.Anisocoria is a common condition, defined by a difference of 0.4 mm or more between the sizes of the pupils of the eyes. Treatment depends on identifying and addressing the underlying problem. Neuroimaging with MRI (occasionally CT) depending on the person’s history and what is found on neuro-ophthalmic and neurologic examinations. Taking a careful history of symptoms, noting when they started and what other problems may be present.Ĭhecking the ability of each pupil to constrict in the presence of bright light and to dilate in the darkness. If the problem is new, the doctor will then focus on which pupil is responding differently. When a doctor sees a patient for uneven pupil size, the first concern is to determine whether the unevenness is new or long-standing. Reaction to certain topical dilating medications (such as a pet’s eye drops, or anti-nausea or motion sickness patches such as scopolamine) that may accidentally get into one eye. This may be due to a brain aneurysm, and should be urgently evaluated in the emergency room. On the other hand, a person whose pupils are uneven when they were normal before may be experiencing a serious problem such as:Ī torn or blocked blood vessel in the neck (usually the result of head or neck trauma), which could cause a mildly droopy eyelid on the side of the smaller pupil.Ī third nerve palsy can result in the inability to move the affected eye normally, in addition to eyelid drooping (which is often significant) on the side of the larger pupil. In these cases, there are no other symptoms and both of the person’s pupils react to changes in light. This is called “physiologic anisocoria” and is normal. Slight differences between the two pupils may be present in up to 20 percent of people. This is to rule out eye conditions such as acute angle closure glaucoma or inflammation of the front part of the eye (uveitis or iritis).
More often than not, it is pointed out to the person by someone close to them.Īn ophthalmologist should be seen to rule out ocular causes of eye pain and pupil asymmetry, especially when vision loss or changes, redness or discharge from the eye(s) is present.
#Migraine unequal pupil size professional
Uneven pupil size may be noticed by the person or by a health professional during an examination.
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