![]() Patients presenting with an acute history of Horner’s syndrome with neck pain and dysphagia require an urgent MRI neck to investigate for carotid artery dissection.Ī diagnosis of Horner’s can be confirmed by administering 0.5% apraclonidine (alpha-2 agonist) eye drops which will dilate the miotic pupil and correct the anisocoria. Postganglionic (no anhidrosis): carotid artery dissection, cavernous sinus thrombosis, cluster headaches.Preganglionic (anhidrosis of face): Pancoast tumour, thyroid mass, cervical rib.Central: stroke, multiple sclerosis, tumours.Horner’s syndrome is characterised by the triad of miosis, anhidrosis and ptosis (due to disruption to the sympathetic innervation of the Muller’s muscle). Pharmacological: pilocarpine, organophosphate insecticides.Mechanical: trauma, previous surgery, secondary to inflammation (anterior uveitis).Argyll-Robertson pupil: characteristic of neurosyphilis, seen usually as bilaterally constricted pupils that can accommodate but not react to light.These pupils typically represent a disruption of the sympathetic nervous system (e.g. The abnormal pupil can be identified by its failure to dilate in the dark thereby appearing constricted (miotic). For more information, see the Geeky Medics guide to the examination of the eyes and vision. This should include checking accommodation and pupillary light reflexes, as well as slit-lamp examination. Therefore, assessment of the pupil should take place in both light and dark conditions. Pathological anisocoria can be identified by worsening anisocoria in either light or dark conditions. 2Ĭlinical examination should demonstrate a difference of less than 1mm between pupil size which typically remains the same in both light and dark conditions. ![]() ![]() Physiological anisocoria occurs in up to 20% of the population but the exact cause is unknown. However, if you have the symptoms of Horner syndrome described above, or if your pupils change size suddenly throughout your adult life, it is highly recommended to seek medical attention as soon as possible.You might also be interested in our medical flashcard collection which contains over 1000 flashcards that cover key medical topics. For many people who do experience differentiated pupils, it is not a new condition and tends to be present from birth. While most of the time having unequal sized pupils results in little or no damage to one’s vision, for others the impact of differentiated pupils can be life-changing. When to consult your local independent optician This depends on the type of drug you have taken but in all cases our pupils resume to their regular size once the effects of the drug have worn off. Our pupils commonly increase in size when we are under the influence of recreational drugs which send stimulating signals to our nerves which can either increase or decrease the size of our pupils. If you are experiencing any of these symptoms then you should get medical attention immediately. This syndrome typically results in a reduced pupil size in one eye and is joined by a series of other symptoms such as droopy eyelid and decreased sweating in the impacted side of your face and eye. This syndrome is the outcome of a disruption of nerves between the brain towards the face and eye on one side of the body only. If you are experiencing a reduced pupil size on one side of your face it might be an indication that you are suffering from Horner syndrome. However, if you also experience additional symptoms, such as drooping eyelids or fever, you ought to seek medical attention as soon as possible. For some people who have anisocoria, there is no impact upon one’s sight, which is termed physiologic anisocoria. This condition means that your pupils will not necessarily be identical. ![]() If you happen to notice that your pupils are dilating to different extents at the same time it might be that you have an eye condition called anisocoria. Here are some of the main reasons for why your pupils are different sizes. This is particularly common when other symptoms are present as well. Normally our pupils tend to be identical in terms of when and how much they dilate, but for some people, a differentiated pupil size can be indicative of an underlying health problem. Most of us probably don’t spend much time looking at the shape or size of our pupils. ![]()
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