Common Causes
¿Qué es la anisocoria? Anisocoria is when your eye’s pupils are not the same size. The pupil allows light to enter the eye so that you can see. Anyone can have pupils that differ in size with no problems. In fact, one out of five people have pupils that are normally different sizes.
Related Conditions
Anisocoria is sometimes the first sign people notice of a life-threatening underlying condition like a stroke or aneurysm. What is anisocoria? Anisocoria is the medical term for when one of your pupils is bigger than the other.
What is anisocoria and why does it matter?
Examples of conditions that can result in pathologic anisocoria include: Iritis. This type of uveitis (inflammatory eye disease) results from an eye infection, eye injury, or separate inflammatory eye disease. Horner’s syndrome. The disruption of a nerve pathway that runs from the brain to the face and eye (on one side of the body).
Is anisocoria a sign of a stroke?
In the diagnostic work-up for anisocoria, it is useful to distinguish between anisocoria that is greater in the dark and anisocoria that is greater in the light. This is followed by a series of pharmacologic tests to further determine the exact etiology.
What is an example of pathologic anisocoria?
What is the diagnostic work-up for anisocoria?
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What is anisocoria caused by?
Generally, anisocoria is caused by impaired dilation (a sympathetic response) or impaired constriction (a parasympathetic response) of pupils. An injury or lesion in either pathway may result in changes in pupil size.
Is anisocoria harmful?
Physiological anisocoria is when there is a natural, small difference in the size of a person's pupils. This is not harmful and does not require treatment. However, a sudden and pronounced change in one pupil size can indicate a medical condition.
What does it mean if a patient has anisocoria?
Anisocoria is when your eye's pupils are not the same size. The pupil allows light to enter the eye so that you can see. Anyone can have pupils that differ in size with no problems.
How do you fix anisocoria?
Your doctor's recommended treatment plan will depend on the underlying cause of your anisocoria. For example, if an infection is the cause, your doctor might prescribe antibiotic or antiviral eye drops. If you have an abnormal growth, such as a brain tumor, your doctor might recommend surgery to remove it.
Can anisocoria cause blindness?
Anisocoria cannot make you go blind. Though many causes of anisocoria are benign and some people only notice some blurry vision and/or light sensitivity, it can be a sign of a serious and potentially life-threatening neurological problem.
Can anisocoria be caused by anxiety?
Although the autonomic system is usually balanced, stress can lead to increased autonomic asymmetry.
Is there a cure for anisocoria?
Treatment for anisocoria itself is usually not necessary. However, bifocals or reading glasses may be beneficial if uneven pupils cause unequal accommodation. With benign cases of this condition, a doctor might recommend photochromic lenses.
What drugs cause anisocoria?
Severe illnesses and various anticholinergic and sympathomimetic drugs may also cause anisocoria and mydriasis. The authors cite that anisocoria and mydriasis have occurred with fluvoxamine, bupropion, paroxetine, and sertraline.
What type of doctor treats anisocoria?
The precise cause of this type of anisocoria has yet to be discovered. If you have different size pupils, contact an eye doctor near you, who can diagnose and treat the condition.
How do you test for anisocoria?
In practical terms, when faced with anisocoria, ophthalmologists need to confirm the finding by measuring pupil size in each eye in ambient room light. Then the pupils need to be measured in different light conditions (dark and bright light). It is also important to note any other obvious features such as ptosis.
Can stroke cause anisocoria?
In an intensive care setting, 19% of patients were found to have anisocoria on exam and 68% of these patients had a stroke diagnosis (4). Another study using stroke registry data found the incidence of anisocoria in acute stroke presentation to be lower, between 5.8 and 9.5%.
What does it mean when 1 pupil is bigger than the other?
If there are no other symptoms and if the pupils return to normal, then it is nothing to worry about. 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.
How to diagnose anisocoria?
Anisocoria Diagnosis. To diagnose anisocoria, your ophthalmologist will examine your pupilsin both a lighted room and a dark room. This allows them to see how your pupils respond to light. This can help them figure out which pupil is abnormal. Your ophthalmologist will also check your eyes with a slit-lamp microscope.
Does anisocoria affect eyesight?
Usually anisocoria does not need to be treated since it does not affect eyesight or eye health. If anisocoria is related to an eye health problem, that problem will need to be treated. If you have questions about anisocoria, be sure to ask your eye doctor. Your ophthalmologist is committed to protecting your sight.
What are the symptoms of anisocoria?
For example, you might experience: blurred vision. double vision. loss of vision. headache. fever. nausea. stiff neck.
What to do if you have an anisocoria?
For example, if an infection is the cause, your doctor might prescribe antibiotic or antiviral eye drops. If you have an abnormal growth, such as a brain tumor, your doctor might recommend surgery to remove it.
What tests can help diagnose anisocoria?
Depending on your symptoms and medical history, your doctor might order one or more tests to help diagnose the underlying cause of your anisocoria. These tests might include: eye exams. complete blood count (CBC) blood differential. lumbar puncture, or spinal tap. CT scan.
Can you predict anisocoria?
In some cases, you’re not able to predict or prevent anisocoria. However, you can take steps to reduce your risk of developing uneven pupils. For example: Report any changes to your vision to your doctor immediately. Wear a helmet while playing contact sports, cycling, or horseback riding.
Overview
Anisocoria is the medical term for when one of your pupils is bigger than the other.
Symptoms and Causes
Anisocoria can be accompanied by serious symptoms. Go to the emergency room if one pupil is bigger than the other and you experience any of the following:
Diagnosis and Tests
Your healthcare provider will diagnose anisocoria by looking at your eyes and performing a physical exam to check for other symptoms. You might need imaging tests, including:
Management and Treatment
Treating what’s causing anisocoria is more important than treating the irregularity in your pupils.
Prevention
Because anisocoria can be caused by such a wide range of conditions, there’s no one surefire way to prevent it. Have your eyes examined regularly, and see your provider annually for a checkup.
Living With
Visit your healthcare provider or go to the emergency room right away if you notice any changes in your eyes or vision, including if your pupils are irregularly sized.
Types of Anisocoria
Characterization of anisocoria includes unequal pupil sizes. While the condition is common, the causes may or may not be benign .
Accompanying Symptoms of Anisocoria
Many people do not realize that their pupils vary in size. It may become apparent when they compare old and newer photos of themselves.
How is Anisocoria Diagnosed?
If you think you have anisocoria, you should speak with your ophthalmologist or healthcare professional.
When is Anisocoria Normal? When is Treatment Necessary?
Not all types of anisocoria will require treatment or indicate a serious health condition.
How to Correct Different Pupil Sizes
Correcting different pupil sizes will depend on the type of anisocoria you have.
Is Anisocoria Preventable?
Anisocoria may be preventable in some cases. For example, in pharmacologic anisocoria, stopping the administration of the pharmacologic agent causing the issue could provide relief.
What is anisocoria?
Anisocoria is a condition characterized by unequal pupil sizes. It is relatively common, and causes vary from benign physiologic anisocoria to potentially life-threatening emergencies. Thus, thorough clinical evaluation is important for the appropriate diagnosis and management of the underlying cause.
Why is anisocoria greater in the dark?
Anisocoria is greater in the dark due to a defect in the pupillary dilator response secondary to lesions along the sympathetic trunk. Central or first-order lesions are often caused by stroke, lateral medullary syndrome, neck trauma or demyelinating disease.
What causes adie's tonic pupil?
Causes include Adie’s tonic pupil, oculomotor nerve palsy, traumatic injury to the iris, or pharmacologic dilation from mydriatics/cycloplegics (atropine, tropicamide, cyclopentolate), or cocaine. The use of pilocarpine can be diagnostic in this setting.
What is Horner's syndrome?
Horner’s syndrome (oculosympathetic palsy) is classically described by the triad of ptosis, miosis, and anhidrosis, although clinical presentations may vary. Anisocoria is greater in the dark due to a defect in the pupillary dilator response secondary to lesions along the sympathetic trunk.
What are some examples of congenital anomalies in the iris?
Examples include aniridia, coloboma, and ectopic pupil. Mechanical anisocoria is an acquired defect that results from damage to the iris or its supporting structures.
Does pilocarpine constrict the pupil?
Low doses of 0.1% pilocarpine or 2.5% methacholine do not constrict a normal pupil but result in the constriction of Adie’s tonic pupil due to hypersensitivity from the upregulation of cholinergic receptors. If no constriction is observed, a higher dose of 1% pilocarpine is used.