A complete eye examination is performed by a pediatric ophthalmologist or neuro-ophthalmologist to evaluate vision, eyelid position, how the eyes move, and the health of the front and back portions of the eyes among other things.
The doctor will evaluate the size of the pupils and how they react to bright and dim light. Based on the evaluation, the doctor may wish to perform additional tests with eyedrops or perform laboratory or radiologic testing. One of the most important parts in the evaluation of anisocoria is determining which pupil is abnormal. 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.
On the other hand, if the difference in pupil size increases in bright light, then the larger mydriatic pupil may be the abnormal one because it is not getting small or constricting normally. After trauma to the eye, the colored part of the eye i.
This is a condition most common in young adult females, which usually begins in one eye. The pupil is slow to react to light. Many people with this condition will also have diminished deep tendon reflexes and they can have trouble focusing at near.
The condition is usually not associated with any serious conditions. Some eyedrops, nasal sprays, or other medications can have a dilating effect on the pupil. There have been cases of prescription anti-perspirant wipes that have accidentally gotten in the eye and caused temporary pupil dilation. Finally, an abnormality of the third cranial nerve a nerve that comes from the brain to the eye and controls eyelid position, eye movement, and pupil size can cause an abnormality of the pupil.
In this condition, there is often droopiness otherwise known as ptosis of the upper eyelid on the same side as the larger dilated pupil. 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.
The use of eye drops is a common cause of a harmless change in pupil size. Other medicines that get in the eyes, including medicine from asthma inhalers, can change pupil size. Treatment depends on the cause of the unequal pupil size. You should see a health care provider if you have sudden changes that result in unequal pupil size. Contact a provider if you have persistent, unexplained, or sudden changes in pupil size.
If there is any recent change in pupil size, it may be a sign of a very serious condition. Your provider will perform a physical exam and ask questions about your symptoms and medical history, including:. Balcer JL. If the problem is new, the doctor will then focus on which pupil is responding differently. The examination may involve:. Taking a careful history of symptoms, noting when they started and what other problems may be present. Checking the ability of each pupil to constrict in the presence of bright light and to dilate in the darkness.
Treatment depends on identifying and addressing the underlying problem. For physiologic anisocoria, no treatment is needed. Health Home Conditions and Diseases. An abnormally dilated eye may indicate a serious neurologic problem which needs to be investigated immediately, even if there are no other apparent symptoms.
Your ophthalmologist will be able to determine if this is due to a benign condition or something more serious. If you do not have an eye doctor who is accessible, go to the emergency room immediately for evaluation. Ask a New Question. Not every question will receive a direct response from an ophthalmologist.
However, we will follow up with suggested ways to find appropriate information related to your question. Medical disclaimer. By submitting your question, you agree to be answered by email.
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