![]() ![]() It is also important to note any obvious abnormalities in the shape of the pupil. Look at both pupils in ambient room light conditions and measure size of the pupil in each eye. The second question to answer is which pupil is the defective one. The first question facing the ophthalmologist is to ascertain if anisocoria is present or not. It is a sign of an abnormality in the efferent pathway. However, if multiple sclerosis has caused damage to the 2nd or 3rd cranial nerves, then you may show anisocoria.Anisocoria means the presence of difference in the size of the right and left pupils. There are so many possible causes of anisocoria that MS is not at the top of the differential diagnosis list. Medical causes include Holmes-Adie pupil, 3rd cranial nerve (oculomotor nerve) palsy, exposure to drugs which dilate the eye (such as cold medications, hallucinogens, and dilating eye drops), or use of anticholinergic agents (which are commonly used to treat asthma, urinary bladder spasms, and motion sickness). The affect pupil will stay dilated rather than constrict to restrict the amount of light which enters the eye. Medical causes include Horner’s syndrome, Argyll Robertson pupil, and cluster headaches.Īnisocoria which is greater in bright light (or less in dim light) suggests a problem with parasympathetic nerve input. The affected pupil will stay constricted rather than dilate to let additional light into the eye. Neurological causes can involve either the sympathetic nerve input (which dilates the pupil) or the parasympathetic nerve input (which constricts the pupil).Īnisocoria which is greater in dim light or darkness suggests a problem with sympathetic nerve input. Structural causes include ocular infection, trauma, inflammation, or surgery. What Are Possible Causes of Anisocoria?īesides occurring naturally in a low percentage of the popuation, anisocoria can be caused by structural or neurological conditions. In cases of physiologic anisocoria, the difference in pupil size is usually mild, not more than one millimeter, and does not differ with the degree of ambient light. When anisocoria is not caused by an underlying medical condition, it is called physiologic anisocoria. The amount of different in pupil size can vary from day-to-day and even switch eyes. Approximately 15-20% of the general population has anisocoria without an underlying medical cause. What Is anisocoria?Īnisocoria refers to an inequality of pupil size. My eyes continue to show Anisocoria in addition to the Relative Afferent Pupillary Defect (RAPD), a condition which we discussed last week. My MRI came out clean and the clinic made me a special pair of reading glasses.Īlthough my brain was clear, my eyes still displayed Anisocoria. No mention of other conditions which might affect the eyes (including MS). I do know that the doctors wanted to eliminate the possibility of a brain tumor. I didn’t know enough at the time to ask lots of questions. This discovery, along with my symptoms and examination, prompted the ophthalmologist to order a brain MRI. Pictures from high school showed that indeed my pupils had NOT always differed in size. ![]() Since I couldn’t answer the question, they wanted to see photos of me from various years to see if my pupils had always appeared to be different sizes. I wasn’t really even aware of the issue, having not noticed the difference in my own reflexion. They wanted to know if my pupils had always been that way. One thing which concerned the doctors was that my pupils were of different sizes. I was quite the guinea pig in the campus Eye Clinic. Very interesting to have both students and professionals examine my eyes. This was my first time to be examined by anybody I didn’t know. I had been a patient in the same doctor’s office since I was 4 years old. For my entire life up to this point, I had only visited one eye clinic for all my care. ![]()
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