Anisocoria: one pupil bigger than the other

This is a benign condition that causes the pupils to differ in size, usually by up to one millimeter in diameter, without affecting the pupils’ response to light. This condition can be intermittent or constant, and may even go away on its own without medical intervention. The most common cause of unequal pupils is physiological (also known as simple or essential anisocoria), which means the pupil difference is due to how unequal pupils usually indicate the body was formed.

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• Anisocoria is usually not a cause for concern, but it may be an indication of an underlying and potentially life-threatening condition, such as an aneurysm or stroke.
• Physiologic anisocoria is the most common form, with between 15-30% of the population experiencing it.
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• Discuss a plan of action with your healthcare provider if you have a chronic condition that can cause unequal pupils, such as MS or a ventricular shunt.

If posterior synechiae (abnormal connections between the iris and the lens) develop, the pupil may not be able to dilate fully. This can be caused by uveitis, angle-closure glaucoma, or other inflammatory conditions. The best way to evaluate for posterior synechiae is with a slit lamp examination.

Key Facts About Anisocoria

For example if the difference is greatest in dark conditions, the smaller pupil is the abnormal one and may indicate Horner’s syndrome. In most cases of anisocoria, unequal pupils are not usually significant enough for anyone to notice. Anisocoria is a condition where one of the pupils in your eye is a different size to the other.

• Anisocoria is a term derived from two Greek words, “aniso-” meaning unequal, “kore” meaning pupil, and a Latin suffix “ia” meaning abnormal condition.
• Doctors first ask questions about the person’s symptoms and medical history, including questions about smoking.
• Anisocoria greater in the light indicates the large pupil is the abnormal pupil due to poor pupillary constriction.
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• Common symptoms include blurry vision, light sensitivity, and eye pain or discomfort.
• Anisocoria is the medical term for one of your pupils being bigger than the other.

Pathologic anisocoria

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Then the goal is to decide whether the larger or the smaller pupil represents the problem. The following information can help people decide when a doctor’s evaluation is needed and help them know what to expect during the evaluation. Pupils, the dark circles in your eyes, are usually equal in size. Horner’s syndrome typically is caused by an underlying medical problem, such as a stroke, tumor or spinal cord injury.

Treatment Options for Anisocoria

There is no difference in mortality from most causes anisocoria compared to the general population, with the exception of two causative conditions. Anhidrosis is typically present in cases of central (1 order) or pre-ganglionic (2 order) lesions. Although the classical clinical features are sufficient to diagnose Horner syndrome, several pharmacological tests are available to confirm a case of suspected Horner syndrome, as summarised in Table 2.

Simple anisocoria

Pathologic anisocoria develops from an underlying disease or condition, often iritis. Anisocoria may be diagnosed if one pupil is bigger or smaller than the other. In some cases, the pupils may continue to respond normally to light, while in other cases, their responses may differ from one another. The pupil controls the amount of light that enters the eye by widening and constricting in response to light intensity. Eye drops that cause activation of the dilator pupillae can cause mydriasis of the pupil.