Treatment depends on the cause of the unequal pupil size. Pupils that respond more to accommodation than light.Anhidrosis (reduced sweating on the face of the affected side).Red flags – The following findings are of particular concern: Serious disorders should be considered in patients with Horner syndrome or 3rd cranial nerve palsy. Many disorders are accompanied by anisocoria due to iris or neurologic dysfunction but usually manifest with other, more bothersome symptoms (e.g., uveitis, stroke, subarachnoid hemorrhage, acute angle-closure glaucoma).Įxamining the pupils in light and dark and inspecting an old photograph or the driver’s license of the patient provide a great deal of diagnostic information. Unequal pupil sizes of more than 1 mm that develop later in life and do NOT return to equal size may be a sign of an eye, brain, blood vessel, or nerve disease. If there are no other symptoms and if the pupils return to normal, then it is nothing to worry about. If other family members also have similar pupils, then the pupil size difference could be genetic and is nothing to worry about.Īlso, for unknown reasons, pupils may temporarily differ in size. The difference between pupil sizes in physiologic anisocoria is typically ≤ about 1 mm.īabies born with anisocoria (different sized pupils) may not have any underlying disorder. Most often, the diameter difference is less than 0.5 mm, but it can be up to 1 mm (0.05 inch). Physiologic anisocoria: slight differences in pupil sizes are found in up to 1 in 5 healthy people. Therefore thorough clinical evaluation is important for the appropriate diagnosis and management of the underlying cause. Anisocoria is a relatively common condition, and causes vary from benign physiologic anisocoria to potentially life-threatening emergencies. It gets larger in dim light and smaller in bright light. The pupil is the black part in the center of the eye. Anisocoria is a condition characterized by unequal pupil sizes 1.
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