Conversely, if the difference in pupil size increases in bright lighting, then the larger (mydriatic) pupil may be the abnormal one because it is not constricting normally. If the difference in size between the pupils increases in the dark, then the smaller (miotic) pupil may not be dilating well and could be the abnormal one. One of the most important parts in the evaluation of anisocoria is determining which pupil is abnormal. How does the doctor know if the big pupil is ‘too big’ or the small pupil is ‘too small’? Based on the evaluation, the doctor may wish to perform additional tests with eyedrops or perform laboratory or radiologic testing. The doctor will evaluate the size of the pupils and how they react to bright and dim lighting. A complete eye examination by a pediatric ophthalmologist is performed and will evaluate the vision, eyelid position, how the eyes move, the health of the front and/or back portions of the eyes (among other things). How does the doctor determine whether anisocoria is due to an underlying medical problem?Ĭertain characteristics, such as when the anisocoria was first noted, whether it is more noticeable in bright or dim illumination, and whether or not there was a preceding event that could be related, will help determine the underlying cause. Typically with physiologic anisocoria, the difference in pupil size between the two eyes does not exceed one millimeter. Anisocoria that is NOT associated with or due to an underlying medical condition is called physiologic anisocoria. The amount of anisocoria can vary from day-to-day and can even switch eyes. The presence of anisocoria can be normal (physiologic), or it can be a sign of an underlying medical condition.Īpproximately 20% of the population has anisocoria. The term anisocoria refers to pupils that are different sizes at the same time. Normally the size of the pupil is the same in each eye, with both eyes dilating or constricting together. Is it normal to have pupils of different sizes? When in a bright room or outdoors the pupil usually constricts conversely when in a dark room the pupil usually dilates to allow more light to enter the eye. The empty hole in the middle, which allows light to enter the eye, is called the pupil. It is a circular muscle, similar in shape to a donut. But further testing may be needed if there are definite signs of concern.The colored part of the eye is called the iris. Most of the time young children with anisocoria do not have other abnormalities and we'll watch them carefully over time. For this reason, unequal pupil sizes should prompt a complete eye exam. The most pressing concern with Horner’s Syndrome in young children is a type of cancer called Neuroblastoma that can happen along the spinal cord in the neck and affect that sympathetic nerve. Horner’s syndrome may be most commonly caused by this nerve not forming correctly during development or from birth trauma to the neck. This can result in several abnormalities including anisocoria, ptosis (droopy eyelid), and asymmetric facial flushing. In young children, our biggest concern is looking for signs of something called Horner’s syndrome, where a nerve, called the sympathetic nerve, coming up to the face from the neck is not functioning properly. Unequal pupils can also sometimes occur as a result of exposure to some medications or drugs that affect pupils size. In some people, this could be normal for them and not of any concern, though in these cases the difference in size is usually relatively small. "Anisocoria" is the medical term for unequal pupil sizes.Īnisocoria may be present for a number of reasons. Either the parents or the primary care doctor may notice this difference early in life. We often see new young patients to evaluate one pupil being larger than the other. Eye Misalignment / Strabismus (Children)Īnisocoria (Different Size Pupils in Children) Unequal Size Pupils.Anisocoria (Different Size Pupils in Children).
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