FAQ - anisocoria
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A few questions about anisocoria...answers from professionals would be appreciated?


My G.P. noticed my Anisocoria when I was 17. Looking back at photos, it seems like it started around age 13 or 14. I've been wearing corrective lenses since I was 6 or 7 (currently -6.5 & -7). Shouldn't my optometrist have noticed it before then? Do they even look for it?

I'm 31 now. When my G.P. noticed the condition, she didn't do anything about. She just said it was pretty common & nothing to worry about. But I've read that it can be a symptom of different brain/nervous system diseases. Is it possible that it could be seen as benign & I might later develop something more serious related to the anisocoria?

And lastly, my case is very mild. I've had boyfriends notice it, but on an everyday level, no one really notices it unless I point it out to them. Does it get worse with age?

Thanks for any help! :)
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From what you describe, it sounds like you have physiological anisocoria. This is very common an actually affects 20% of the population. this means that you have a natural difference in the size of your pupils but it is not related in any way to a nervous defect.

Yes your optometrist routinely screens how your pupils work for every person, and as this is common and not worrisome, chances are that they just simply recorded it but did not tell you about it. If it was caused by a nervous defect then it would have showed up in your eye tests.

It is certainly not a progressive disorder and is not likely to develop into anything sinister over time. your chances of developing a problem in your brain are exactly the same as anyone else - it does not put you into a higher risk at all. It wont get worse with age either.

Rest assured that the advise you have been given by your GP was all correct.  (+ info)

Help me diagnosis the cause of my alternating/seesaw anisocoria please?


OK so I'm 16 years old and noticed while staring into my eyes that my eyes were unequal size (like half a year ago I first noticed). I had it "diagnosed" by some kind eye doctor who said it's nothing to worry about. She did the regular eye tests with the light and all that.. They gave me glasses too =( but I don't really need them..

Anyway, she called it Physiological -- meaning I was "born" with it. Who knows, I don't usually stare into my eyes, maybe I was. My parents don't have it by the way, and neither does anyone in my family that I can think of.

My mom says she doesn't even see a pupil difference, but I see a significant difference. My pupils respond normally and equally to light, but the weird thing is, they aren't ALWAYS different sizes.. And some days the right one will be larger, and other days the left one will be larger. It just switches. So, I narrowed it down to "Seesaw Anisocoria".
HOPEFULLY Physiological..

But, I don't even understand from a medical standpoint, HOW it's possible to have seesaw anisocoria? Like, what processes can happen differently that the pupil actually switches!? Whether it's being caused by something like a tumor or an aneurysm, or (hopefully) just physiological, I just don't understand how it's possible.

Can anyone please try to break it down for me? Am I missing something? How is this possible? What could I have?

**Also -- I believe chest tumors have some relation to anisocoria, just out of hypothetical curiosity, how is that?**

(Please, do not be afraid to tell it like it is)
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Are you sure it's alternating? Or is one pupil somewhat fixed in size and the other gets bigger and smaller normally, so sometimes it's bigger than the fixed pupil and sometimes smaller?  (+ info)

What causes alternating/seesaw anisocoria? (& Difficult Diagnosis...)?


OK so I'm 16 years old and noticed while staring into my eyes that my eyes were unequal size (like half a year ago I first noticed). I had it "diagnosed" by some kind eye doctor who said it's nothing to worry about. She did the regular eye tests with the light and all that.. They gave me glasses too =( but I don't really need them..

Anyway, she called it Physiological -- meaning I was "born" with it. Who knows, I don't usually stare into my eyes, maybe I was. My parents don't have it by the way, and neither does anyone in my family that I can think of.

My mom says she doesn't even see a pupil difference, but I see a significant difference. My pupils respond normally and equally to light, but the weird thing is, they aren't ALWAYS different sizes.. And some days the right one will be larger, and other days the left one will be larger. It just switches. So, I narrowed it down to "Seesaw Anisocoria".
HOPEFULLY Physiological..

But, I don't even understand from a medical standpoint, HOW it's possible to have seesaw anisocoria? Like, what processes can happen differently that the pupil actually switches!? Whether it's being caused by something like a tumor or an aneurysm, or (hopefully) just physiological, I just don't understand how it's possible.

Can anyone please try to break it down for me? Am I missing something? How is this possible? What could I have?

**Also -- I believe chest tumors have some relation to anisocoria, just out of hypothetical curiosity, how is that?**

(Please, do not be afraid to tell it like it is)
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Pupils do tell you a lot when in your case it is anisocoric. The sympathetic chain or horner's syndrome is what you are referring to that is being affected. That is due to the fact that the pathway crosses the apex of the lungs and up to the pupil muscles. If there is indeed a "chest tumor" from what you suspect, it will block the neronal pathway, resulting in one eye CONSTANTLY being smaller than nonaffected eye, because the innervation to the dilator muscle of the iris is blocked. You stated that you have alternating anisocoria, so i would not worry about it.  (+ info)

Any cure for Anisocoria?


see edit below>>>

There are many causes...so there could be many different avenues of treatment depending upon the cause..

Anisocoria (unequal pupils)

http://www.medfriendly.com/anisocoria.html (definition and causes)
http://www.emedicine.com/oph/topic160.htm#section~treatment (causes…scroll down to section 4..differential diagnosis and other problems to be considered…these could be other causes to rule out…)
http://en.wikipedia.org/wiki/Anisocoria (wikipedia)
http://en.wikipedia.org/wiki/Wernicke-Korsakoff_syndrome (sometimes seen in Wernicke-Korsakoff syndrome)
http://en.wikipedia.org/wiki/Horner%27s_syndrome (sometimes seen in Horner’s syndrome)
http://en.wikipedia.org/wiki/Oculomotor_nerve (sometimes seen in oculomotor nerve palsy)
http://en.wikipedia.org/wiki/Marcus_Gunn_phenomenon (if with Marcus Gunn phenomenon, then suspect optic neuritis or retinal detachment)



I don’t know if it is in these books or not…as it is sort of a symptom of something else going on…

3 books on disease symptoms and treatments

you could also get these books on ebay or amazon or a half price book store. (last two are very similar)..
1.Oxford Handbook of Clinical Medicine
2.Handbook of Diseases (Lippencott)
3.Professional Guide to Diseases (Springhouse)

Edit- I looked this up in Oxford Handbook . and it is in there on pg 54 and 56 of 3rd edition...it says may be due to unilateral lesion, or drug application, syphillis, or be a Holmes-Adie pupil (see below). Some inequality may be normal.

Holmes-Adie (myotonic) pupil-This is a benign condition that occurs usually in women and is unilateral in about 80% of cases. The affected pupil is moderately dilated and is poorly reactive to light (if at all). It is slowly reactive to accomodation ;wait and watch carefully; it may eventually constrict to a more normal pupil. It is often associated with diminished or absent ankle and knee reflexes, in which case the Holmes-Adie syndrome is also present.

Argyll Robertson pupil-This occurs in neurosyphillis, but a similar phenomenon may occur in diabetes mellitis. The pupil is constricted. It is unreactive to light , but reacts to accomodation. The iris is usually patchily atrophied and depigmented.

Hutchinson Pupil-This refers to the sequence of events resulting from rapidly rising intracranial pressure (ie intracerebral hemmorhage).The pupil on the side of the lesion first constricts then widely dilates.The other pupil then goes thru the same sequence.  (+ info)

My right pupil is bigger than the other?


I looked in the mirror last night and recognized that my right pupil is just Slightly bigger than the other. Just slightly though, not alot. no one has ever said anything about it so i don't think anyone can recognize it.

Is this Anisocoria?
americancheese:
I don't smoke, or take drugs or anything like that.
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  (+ info)

Ever heard of "Anisocoria"?


Do you know someone with this disorder?
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means the size of the pupils are not the same. anisocoria-- an (not), iso (same) coria (pupils).

can be normal in some people when the measurement is just 1mm difference. normal pupil size when light is directly shined over the eye is 2mm - 3mm.

usually seen in patients with a brain tumor, or hydrocephalus, or any brain lesion that will cause an increase in pressure in the brain. the more the difference in size, the higher the degree of brain compression, the worst the prognosis.

hope this helps. goodluck  (+ info)

Questions about Physiological Anisocoria (Please Answer)?


Is it normal for people with physiological anisocornia to have the larger pupil switch between eyes and go on/off being equally sized?

Why is this? Thank you.
Because it's not the most confusing question in the world. I'm asking if this is normal. I'm just making sure.
Alright, thank you. I just keep asking because I am scared, to be honest. I don't recall my pupils ever being different sizes. I'm 15, so I'm young and a little bit of a hypochondriac just trying t make sure I don't have a brain tumor...

I don't know if my eye doctor can be sure I'm fine.

But at the same time, my mom can't afford a flase alarm for MRI's and other brain scans... sorry to seem to paranoid. But with high levels of anxiety, it's hard to tell what's real and what's an illusion.
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Don't worry, go take a flashlight your self and check your pupils...They may not react very quickly or evenly but do they both get a little smaller? If so that tells me that its not really a tumor, as with some of the patients ive seen with tumors their pupils do not react at all. Or if they do react its that they get small and then HUGE with in .005 sec of getting small. I'm sure that your doctor would have sent you for more tests if something was really up.

I am the same way though, i find a freckle on myself that looks weird and the next thing u know im freaking out because I've read somewhere on line that says it may be cancerous.

Do you have health insurance? If so go and get a second opinion at a ophthalmology practice...and they an bill it as a medical reason so that it would be covered by your insurance.  (+ info)

BABY dis-conjugate upward gaze, anisocoria pupil,mild hypotonia eeg normal?what could it be,waiting for mri?


hi sorry,my baby was born with polycythemia,
Congenital Heart Defect{whole between two chambers} an heart murmmer,she really has been through the wars.needed oyagen when born etc,and was on neonatal for a week.since then she has had several problems,the sizures she suffers are triggered from doing to much i think,as pysiotherapy proven.in afternoon lost all sytrengh no musle tone at all compared to the morning.after calling ambulance they said her 1 eye was anisocoria pupil
disconjugate upward gaze,and was
post-ictal state when arrive.were still waiting for mri from last ped appoitment,its worrying me so much.brain EEG was normal so am really puzzled,need to know if anyone has any ideas,being kept in dark cause they dont know what happening to her i think.shes 9 an half months now,kind regrds xx
hi thanks she has got a heart murmer and has had lots of probs,she is under 2 peds,o.t,physio, has hearing impairment too,and because of blood polycymthenia she hasd astroke when born where she showed a smalll hemeoridge on brain scan, x
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Congenital anisocoria, I've heard, can affect up to 20% of the population. It usually runs in families and is nothing to worry about. Your child would be "abnormally normal". However, with the affected eye looking upwards there could be other causes.

Palsy of one of the two 3rd cranial nerves caused by raised inter-canial pressure may cause these symptoms. The MRI would show this, as it could be caused by hydrocephalus. However, it is likely there would be far more signs if this where the case (low heart rate, papilloedema, raisedfontanelss).

Hypotonia is quite common in babies and they can grow out of it without the cause ever being known.

Hope helps a little.  (+ info)

11 yr old with extremely dilated eyes?


My 11 yr old son was diagnosed with Anisocoria about 2 yrs ago. However, we have currently noticed recently that his pupils seem to be extremely dilated all the time. He does wear glasses but has also complained that his vision seems worse. What could cause the eyes to stay dilated all the time. He has blue eyes and at times, you can barely see any blue around the edges.
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The inability to dilate properly is a symptom of the aniscoria. If symptoms are worsening or increasing, it is important to get him to see an ophthalmologist, or possible even a neurologist because it can indicate other issues, such as nerve damage or even a brain tumor. Especially if the dilation has become extreme. Blue eyed people are even more light sensitive to begin with, and the eyes not dilating properly can also cause vision, especially in the near ranges, to be unfocused. But please, get your son to the doctor, if the pupil is not un-dilating at all on its own it can signal serious health issues.  (+ info)

Question about getting contact lenses?


Are there any special contact lenses for "masking" anisocoria or ones that do a good job concealing?
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First have you gone to your eye doctor to know if you have anisocoria and why you have aniscoria to begin with? If this is a new development make sure you see your eye doctor immediately.

If this has been a physiologic thing in which you have had it since birth than there are opaque colored contact lenses and sometimes theatrical lenses that may help to mask it so that the pupils look equal in size. Only an eye doctor can help you with that one. You need to bring it up with your eye doctor when you see him/her.

Good luck  (+ info)

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