One of the most significant is Horner syndrome (below). Many conditions that damage the nerves in the brain or spinal cord can cause anisocoria. In most cases, the causes of this condition are not known, but it can be caused by trauma to the eye (eg, trauma caused by complicated cataract surgery), lack of blood flow (ischemia), or infection. The larger pupil also does not respond to light. Adie’s tonic pupil: This benign anisocoria (also called Adie’s pupil, tonic pupil, or Adie’s syndrome) typically causes one pupil to be drastically larger than the other.Inflammation of the iris: Iritis (anterior uveitis) can cause anisocoria which is accompanied by pain in the eye.Certain eye medications: for example, pilocarpine – eye drops used to treat glaucoma can cause the pupil of one eye to be smaller than the other.Treatment of keratoconus (crosslinking)įigure 1: Normal pupilsFigure 2: Anisocoria with one pupil larger than the otherFigure 3: Anisocoria with one pupil smaller than normalThe reasons for a significant or more severe type of anisocoria (one pupil being larger than the other by more than 1.0 mm) are the following: Anti-VEGF treatment (injections Eleya, Avastin) On the other hand, a CT scan of your head to rule out serious concerns is not unreasonable if the pupillary change is new, especially if accompanied by other symptoms. It is of course very possible that you have had the pupillary variation your entire life, especially since you also notice this trait in your child. (I am not registered as a healthcare professional, however work as a CVICU nurse in a postop setting-I spend my day assessing pupils bc of the risk of stroke in our patient population.) But such traits have been lifelong and typically something that they are aware of.
ONE PUPIL LARGER THAN OTHER PROFESSIONAL
I will say that in my professional experience, it is not uncommon for people to have subtle and minor differences in the size of their pupils. It was certainly nothing like the some of the dramatic images online. She noticed it when applying her eye make-up. I probably would not have noticed it otherwise had she not mentioned it to me. I remember that her pupil was noticeably larger than the other when consciously looking at it.
My only intent is to encourage you to seek definitive answers, especially as you mention that this is a new development for you.
We are thankful for that Adie’s pupil because it was a “symptom” of a significant problem that ended up saving her life!Ĭertainly, I am not suggesting that you have an aneurysm or a neurological condition and I do not mean to scare you. She of course had the aneurysm (successfully!) surgically repaired. As it turned out, she had a cerebral aneurysm compressing one of the cranial nerves, resulting in a cranial nerve palsy which caused the eye dilation. Fortunately, because of the headaches, her internist decided to send her for a CT of the brain “just to be sure” that there wasn’t anything serious being overlooked. Like you, she had several eye exams without any real answers. Abt 4 years ago, my 47 year old sister out of the blue developed this same phenomenon along with frequent headaches. This sounds like it could be what is called Adie’s pupil, a neurological condition with many, many different causes.
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