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Published: Mon, October 09, 2017
World | By Tasha Manning

Anisocoria | University of Maryland Medical Center

Anisocoria | University of Maryland Medical Center

Anisocoria is unequal pupil size.

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The pupil is the black part in the center of the eye. Alternative Names

Enlargement of one pupil;

Pupils of different size; Eyes / pupils different size

Considerations

Slight differences in pupil sizes are found in up to 1 in 5 healthy people. Most often, the diameter difference is less than 0.5 mm, but it can be up to 1 mm (0.05 inch).

Babies born with different sized pupils may not have any underlying disorder. Also, for unknown reasons, pupils may temporarily differ in size.

Also, for unknown reasons, pupils may temporarily differ in size. 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 Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Causes Change in pupil size. Other causes of unequal pupil sizes may include:

  • Aneurysm
  • Bleeding inside the skull caused by head injury
  • or
  • Excess pressure in one eye caused by glaucoma Increased intracranial pressure because of brain swelling, Intracranial hemorrhage, acute stroke, or intracranial tumor
  • Infection of membranes around the brain
  • Migraine headache
  • Seizure (pupil size difference may remain long after Seizure is over)
  • Tumor, mass, or lymph node in the upper chest or lymph node causing pressure on nerve may cause, small pupil, or all on the affected side >
  • Diabetic occulomotor nerve palsy

Treatment depends on the cause of the unequal pupil size. When to Contact a Medical Professional

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Contact a provider if if you are a health care provider if you have sudden changes that result in unequal pupil size.

You have persistent, unexplained, or sudden changes in pupil size. The new development of different-sized pupils may be a sign of a very serious condition.

If you have pupil size after an eye or head injury, get medical help immediately.

Your provider will perform a physical exam and ask Questions about your symptoms and medical history, including:

  • Is this new for you or your pupils ever different sizes before? When did it start?
  • Do you have other vision problems?
  • Do you have any vision problems?

Tests that may be done

References

Baloh RW, Jen J. Neuro-ophthalmology. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016: chap 424.

Dhume KU, Paul KE. Incidence of pupillary involvement, course of anisocoria and ophthalmoplegia in diabetic oculomotor nerve palsy. Indian J Ophtalmol . 2013: 61 (1): 13-7. PMID: 23275215 www.ncbi.nlm.nih.gov/pubmed/23275215.

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