Dilated pupil in one eye causes. Dilated pupil in one eye: what is anisocoria? What to do if your pupils are different sizes. What are the reasons for this phenomenon? Is it dangerous

Pupil functions

The pupil is located in the center of the iris of the eye, and its size can vary depending on lighting conditions. Its main function is to protect the retina from large amounts of light rays. Therefore, in bright light the pupil contracts, and in dim light it dilates. The constriction of the pupil is reflexive - a person does not need to think for any action to occur with the pupil. The pupils of both eyes can simultaneously dilate not only in response to dim light, but also to stress, strong emotional arousal, anger, or due to the use of medications.

The size of a person’s pupil depends on the individual characteristics of the optical system of the eye. People with large eyes tend to have large pupils. It is important that they are the same size and can reflexively respond to changes in light levels. If one eye has a larger pupil than the other, this indicates that changes have occurred in the visual system. Which ones?

One pupil is larger than the other: reasons

Very often, myopic people notice that their eyes are not the same, and the pupil of one eye is larger than the pupil of the other.

The likelihood of this condition increases if the refraction of the eyes is very different. An eye with greater myopia may have a dilated pupil due to excessive visual strain. This condition is temporary and passes quickly. If you notice that the pupils of both eyes are too different, and one of them does not reflexively react to light, then you need to visit not only an ophthalmologist, but also a neurologist to get an accurate picture of your health, since the causes of the pathology can be serious.

One pupil is larger than the other - reasons:

Physiological - the pupil of one eye may be larger if a child or adult has experienced a stressful situation or the dilation of the pupil has been affected by taking medications.
Congenital pathologies - it happens that the pupil is large in only one eye, while the other is of normal size, and this may be due to disturbances in the structure of the iris, dysfunction of the nerves that control the extraocular muscles, etc.
Ophthalmological pathologies - the pupil can become large as a result of severe eye fatigue, especially if there is a strong difference in refraction, myopia, astigmatism.
Others include tumor processes, eye and brain injuries, infectious diseases, and diseases of the nervous system.

Since there are many reasons why one pupil is small and the other is large, a comprehensive diagnosis will be required. You should not hesitate to visit a doctor, as some dangerous diseases manifest themselves asymptomatically. Vision may remain normal for a long time, but it will quickly become poor if treatment for the disease is not started in a timely manner.

The child has different pupils - what to do?

A slight difference in the size of the pupils in adults and children is a physiological norm. If the difference is significant, then it may be associated with congenital anomalies, and not only the pupil, but also visual acuity may differ. Different pupil sizes in children also occur due to underdevelopment of the eye apparatus and are often accompanied by strabismus. Such diseases are diagnosed in early childhood. If you notice that one pupil of a schoolchild is larger or significantly smaller than the other, you should urgently visit a doctor, since such a pathology may be associated with brain injury, tumor, retinal diseases, or damage to the optic nerve.

To exclude dangerous pathologies, comprehensive diagnostics is necessary.

Methods for diagnosing diseases of the pupillary reflex

Since diseases of the pupillary reflex, in which the size of one pupil may be smaller or larger than the other, are often associated with the functioning of the brain, the diagnosis is carried out by both an ophthalmologist and a neurologist. First of all, it is determined whether the pupils react to bright lighting. If one pupil does not have such a reaction, this may indicate damage to the midbrain or tension of the oculomotor nerve.

The main methods for diagnosing diseases in which one pupil becomes large:

study of pupillary reactions using an intense light source;
measurement of intraocular pressure;
ultrasound diagnostics;
CT scan;
studies of the reaction to accommodation with convergence.

During the examination, it is clinically important to establish which eye is in a pathological condition. Anisocoria (different pupils) can be observed when taking medications, traumatic hematomas and hemorrhages that put pressure on the visual centers.

Anisocoria in myopia: features of pathology

The pupils can have different sizes - one pupil is significantly larger than the other if a person has an ophthalmological problem such as anisometropia. With this pathology, the refraction of the left and right eyes is very different, and therefore the visual organs are subject to excessive stress even when corrected with glasses and contact lenses. Correction with contact lenses is the most preferable, as it is possible to achieve the highest possible visual acuity with an optimal level of patient comfort.
If you have myopia with a pronounced difference in the refraction of the eyes and you notice that the pupils differ in size, for example, one is larger than the other, be sure to visit an ophthalmologist for advice. It is possible that it will be possible to get rid of the problem with the correct selection of corrective optics.

Due to eye strain due to myopia, against the background of insufficient or incorrect correction, many ophthalmological problems arise, including spasm of accommodation, impaired outflow of intraocular fluid, increased eye pressure, etc. The main task of a person diagnosed with myopia is to constantly take care of the health of the visual organs, which consists of performing a set of therapeutic and preventive measures.

Anomaly of the pupils due to myopia - treatment and prevention

The development of anisocoria in myopia can be prevented by paying due attention to the prevention of the disease. To prevent the pupil of one eye from becoming larger than the other, it is necessary to reduce the strain on the eyes, improve blood circulation and metabolism in the organs of vision. How to do it?
Treatment and prevention of anisocoria, if one pupil becomes larger than the second due to myopia:

taking eye vitamins with lutein;
eye drops, the action of which is aimed at restoring the protective functions of the eye, improving metabolic processes, and nourishing the tissues of important eye structures;
daily exercises for the eyes - a special set of exercises will help relieve spasm of accommodation, improve visual acuity and strengthen the accommodative muscle;
hiking, swimming, exercise bikes and other useful physical activities allowed for myopia.

If the pupil of an eye with severe myopia is larger than the second one, this may indicate insufficient or incorrectly selected correction. A consultation with an ophthalmologist will help you understand the cause of this condition and find a solution to the problem. The main thing is not to delay visiting a specialist, even if your vision has not become worse, so that the health of your eyes cannot be harmed by disorders that can be successfully treated with timely diagnosis.

Anisocoria is a condition in which the pupils have different sizes. In this case, the reaction to light is different: one pupil remains motionless, while the second narrows and dilates. This pathology may be a consequence of ophthalmological or neurological disorders. Normally, the difference in pupil diameter should not exceed one millimeter.

Anisocoria is not an independent disease, but only a manifestation of other pathologies. A change in pupil size does not always mean the development of some disease. In this article we will talk in more detail about why the pupils are different sizes and find out how this condition can be dealt with. But first, let's find out what it means when the pupils are different sizes.

Types of anisocoria

Sometimes a person may have one pupil smaller in size compared to the other. Experts distinguish physiological and congenital anisocoria. In the first case, the difference in pupil size is no more than one millimeter, and during the examination the doctor does not detect any ophthalmological disorders. This feature can occur in absolutely healthy people.

The congenital form is formed due to defects of the visual apparatus. Moreover, visual acuity is different in each eye. Congenital pathology can also be a consequence of damage to the nervous system of the eyes. This type of anisocoria appears from birth. At the same time, the child does not have a lag in physical and mental development. In some cases, this feature can go away on its own by the age of five, while in others it remains for life.

Acquired anisocoria in adults can be a consequence of injury or ophthalmological diseases. In some cases, this condition may be caused by exposure to inorganic substances, such as belladonna or atropine.

Depending on the degree of damage, the pathology can be unilateral or bilateral. Affecting both eyes is quite rare.

If one pupil is larger than the other, you should consult an ophthalmologist

Causes

The causes of anisocoria can be very different. Different pupil sizes may be a consequence of ophthalmological factors, namely:

uveitis;
iritis;
iridocyclitis;
lens implantation;
surgery on the eye.

Pupils of different sizes can also occur due to other reasons:

cerebral aneurysms;
traumatic brain injury;
pathologies of the oculomotor nerve;
migraine;
hemorrhages;
infectious processes;
genetic predisposition;
cervical osteochondrosis;
syphilis;
epidemic encephalitis;
stroke;
tumor process;
glaucoma;
taking certain medications;
cerebrovascular accidents;
herpes zoster.

When should you see a doctor?

If one pupil has become wider and this condition does not go away, and it cannot be explained, be sure to consult an ophthalmologist. You should be especially wary of the following symptoms:

blurred vision;
fever;
photosensitivity;
double vision;
Pain in the eyes;
headache;
disturbance of consciousness;
temperature increase;
attack of nausea and vomiting.

If you notice that your pupils are different sizes, do not hesitate to consult a doctor.

Diseases that cause changes in the pupil

Let's talk about pathologies, one of the symptoms of which is anisocoria. First, let's discuss paresis of the oculomotor nerve.

The slightest changes in the functioning of the oculomotor nerve affect a person’s quality of life. Children suffer from this disease quite rarely. It is almost impossible to recognize the disease in the initial stages, since it does not manifest itself in any way.

The following reasons can cause nerve paresis:

cervical osteochondrosis;
diabetes;
hypertension;
vasculitis;
carotid artery aneurysm;
tumor process;
heart attack;
stroke;
syphilis, diphtheria, encephalitis, meningitis;
side effects of medications;
injuries;
ocular migraine.

With paresis of the upper eyelid, the eye closes completely or partially. Outwardly, this manifests itself in the form of a squint. Most often, the pathology has a one-sided process. In addition to physical inconvenience, the problem causes aesthetic discomfort. Paresis of the upper eyelid leads to deterioration of visual acuity.

Paresis of the oculomotor nerve is one of the causes of anisocoria

A birth defect is formed as a result of abnormalities in the formation of muscles or intrauterine nerve damage. Acquired pathology can be a manifestation of injuries, as well as neurological disorders.

With mydriasis, the pupil dilates. The disease occurs as a result of injuries, diseases of the nervous system, visual apparatus, as well as the use of potent drugs. Normally, pupil dilation is a natural reaction to lighting. This can also occur during severe emotional stress.

After the diagnosis of “oculomotor nerve palsy” has been established, the patient is registered with a specialist. To avoid mistakes, he is asked to undergo a repeat test. In general, the disease has positive dynamics. Doctors usually recommend doing strengthening exercises for the extraocular muscles. Patients are prescribed vitamins and medications. You may also need to wear bandages or glasses.

Full restoration of nerve mobility occurs after about six months. If there is no result, surgery may be required.

Bernard Horner syndrome

The development of the disease is based on damage to the sympathetic nervous system. The disease affects the muscle tissue of the body, including the visual apparatus. A number of provoking factors can cause the appearance of the syndrome:

damage to brain tissue;
cluster headache;
injuries, including surgical ones;
otitis media;
aortic aneurysm.

Bernard Horner syndrome manifests itself in the form of drooping of the upper eyelid, decreased production of tear fluid, a haggard appearance of the face, unnatural constriction of the pupil, and sunken eyeball. The disease also causes heterochromia, in which the pupils have different colors. In addition, the eye loses its ability to adapt to light. The stronger the level of illumination, the more constricted the pupil, while in the dark it, on the contrary, expands.

In Bernard Horner syndrome, the pupil constricts in bright light and dilates in the dark

The treatment process may include electrical stimulation. Electrodes are attached to the affected areas. The essence of the technique is to stimulate muscles through short electrical impulses. This normalizes blood circulation and in some cases leads to complete recovery.

Problem areas can also be corrected using plastic surgery. Stimulation of affected facial tissues is also possible with the help of drug therapy.

Eydie syndrome

Patients have a slow reaction of the pupils to light, in some cases it is completely absent. Even if you shine a flashlight directly into your eyes, the same braking reaction will be observed. On the affected side, the pupil dilates and becomes deformed.

The disease can be congenital or acquired. The cause of Eydie syndrome can be ophthalmoherpes, atrophy of the eye muscles, meningitis, encephalitis, myotonia.

Treatment includes the use of Polycarpine. Regular use of these drops will help to achieve some improvement in the condition. Glasses are used to correct violations.

Anisocoria in children

If one pupil is larger than the other in a baby, this indicates a congenital pathology. Most often, the cause of such a defect is underdevelopment of the ANS or pathology of the iris. This disorder is often accompanied by the appearance of strabismus and ptosis, that is, drooping of the upper eyelid. If one pupil suddenly becomes larger, this may be a manifestation of the following pathologies:

brain contusion;
tumor process;
aneurysm;
encephalitis.

At an older age, one pupil larger than the other may appear for the following reasons:

injuries;
cerebral edema;
inflammation of the iris;
ophthalmic injuries;
intoxication;
aneurysm;
tumor;
overdose of medications.

In a child, one pupil larger than the other is most often the result of birth defects

Speaking about the reasons that can cause the appearance of pupils of different widths in a baby, it is worth paying attention to relatives. After all, if one of the parents had such a feature, then there is a high probability that such a phenomenon will be repeated in the newborn.

Diagnostics

An ophthalmologist diagnoses anisocoria. To clarify the reasons for this phenomenon, the following studies will be required:

ophthalmoscopy;
measurement of intraocular pressure;
electroencephalography;
Brain MRI;
X-ray of the lungs;
cerebrospinal fluid analysis;
Dopplerography of the blood vessels of the brain.

The photo shows the process of eye ophthalmoscopy

Treatment

The treatment process begins with a consultation with an ophthalmologist and a neurologist. Most often, anisocoria does not require treatment. But this largely depends on the main diagnosis and the provoking factor in the development of the phenomenon. Sometimes the use of anti-inflammatory drugs and antibiotics may be necessary. To relieve spasm and pupil dilation, anticholinergic drugs are used.

To combat inflammatory ophthalmological processes, you will need to take antibiotics, antipyretics and water-salt solutions. If anisocoria develops as a result of a stroke, doctors prescribe medications that thin the blood and dissolve blood clots.

Immediate surgical intervention is required if anisocoria occurs due to head injuries. For meningitis and encephalitis, leading to cerebral edema, complex treatment is required. If the reason lies in the tumor process, surgery will be required.

So, anisocoria is a condition in which the pupils differ in size. It can be physiological or congenital. In this case, treatment is not prescribed. Often, by the age of five or six, this feature goes away on its own. The acquired form can be a consequence of injuries, neoplasms, stroke, pathologies of the iris, and others. Treatment is aimed primarily at eliminating the underlying disease.

Normally, the pupils have the same diameter and react to light synchronously, i.e. friendly. However, it happens that in a child or an adult one pupil is dilated more than the other, and this fact worries a person for good reason. Their unequal size in medicine is called anisocoria, which is a symptom of many disorders of the nervous system, as well as damage to the eye itself.

Causes

Why is one pupil larger than the other? Its diameter is controlled by the centers of the oculomotor nerve - the third pair of cranial nerves. Their nuclei are located in the brain, and their work is normally coordinated. However, sometimes mismatch occurs due to various factors.

There may be several reasons why one pupil is larger than the other:

Migraine or...
Nervous system infections, eclampsia.
Multiple sclerosis of one of a pair of oculomotor nerves.
Congenital pathology.
Traumatic eye injury, inflammation. Inflammatory diseases (iridocyclitis) are the cause of unilateral mydriasis or miosis. Eye injuries lead to damage to the pupillary muscles. As a result, its diameter is not adjusted properly.
Reflex when the lungs are damaged by tuberculosis. When tuberculosis affects the apex of the lung on the affected side, mydriasis of the eye occurs - Roque's symptom.
as a result of strokes and traumatic brain injuries.
Drug use.
Tumors of the central nervous system.
Neck injuries.
Endocrine pathology, thyroid carcinoma.
Eydie syndrome with congenital myotonia, ocular herpes. Herpes zoster and ocular herpes viruses can infect both the pupil itself and the nerves that go to it. As a result, unilateral mydriasis or miosis occurs.

Migraine

Migraine or cluster pain is a common cause of anisocoria. With a migraine, blood circulation is disrupted in one of the hemispheres of the central nervous system. Therefore, its old name is hemicrania. With cluster pain, blood vessels also dilate, swelling of the brain tissue increases, and intracranial pressure increases. Cluster pain and migraine are characterized by Horner's syndrome, which includes miosis of the eye on the affected side, redness of the eyelid and conjunctiva, retraction of the eye, drooping of the eyelid.

Neuroinfections

Infections of the nervous system, such as meningitis, lead to disruption of the nuclei of the oculomotor nerves. In parallel with anisocoria, patients experience weakening or strengthening of reflexes, headaches, and neck stiffness. Patients cannot pull their chin to their neck. Other neurological reflexes are also possible.

Multiple sclerosis

The oculomotor nerve can be affected by an autoimmune nerve disease called multiple sclerosis, which is characterized by the formation of scar tissue in the nerve fibers. The electrical impulse almost stops passing through such nerves. Therefore, the autonomic fibers, as well as the sensory fibers going to the eye, stop working as they should. As a result, the pupils do not respond properly to changes in light.

Hemorrhage

Post-traumatic hematomas can compress important brain structures, such as the brainstem. This leads to herniation and anisocoria. In strokes caused by thrombosis of the arteries supplying the brain or rupture of a vessel, mydriasis or miosis of the eye, and anisocoria may also occur.

Brain tumors and abscesses

Brain tumors, growing, cause edematous processes. Sometimes wedging of the trunk occurs with large tumors. Hemorrhages are also possible when they grow into blood vessels or compress surrounding tissues.

Alcohol or drug intoxication

Usually, with alcohol abuse and taking drugs: cocaine, marijuana, cannabis, both pupils dilate (mydriasis). However, there is also uneven expansion.

Mydriasis is also possible in case of poisoning with belladonna alkaloids - atropine, hyoscine, scopolamine. Constriction of the pupil (miosis) can be caused by organophosphorus compounds and acetylcholinesterase inhibitors: Proserin, Kalimin.

Typically, poisoning is caused by simultaneous mydriasis or miosis. However, if one of the eyes or nerves or centers in the brain is damaged, one of the pupils may not respond to the action of the chemical substance.

Symptoms of diseases with uneven pupil dilation

In addition to mydriasis or miosis, in diseases leading to anisocoria, other signs of disorders are possible. Anisocoria is usually accompanied by the following symptoms:

Torticollis.
The child has heterochromia, i.e. different eye colors.
Visual impairment.
Increased photosensitivity up to photophobia.
With migraines, increased sensitivity to smells and sounds.
Pain in the eyes.

Diagnostics

If there is mydriasis or miosis of the eye, then it is necessary to visit a neurologist or ophthalmologist. Examinations that need to be completed:

Ultrasound of the brain.
Electroencephalography.
Cocaine test.

It is important to learn: problems of the peripheral nervous system and retina.

? Diagnosis and treatment of pathology.

All about: classification, causes, treatment, elimination of the causes of pathology.

Treatment

In case of poisoning, resuscitation measures are necessary: gastric lavage, use of enterosorbents (Smecta, activated carbon).

If anisocoria is caused by a traumatic injury to the nervous system, it is necessary to remove the hematoma that has pressed the brainstem. The operation is performed with craniotomy.

Treatment of multiple sclerosis is carried out using immunosuppressants, glucocorticoids, and donor immunoglobulins to suppress inflammation.

For herpes infection, Acyclovir and interferons are used.

Conclusion

If one pupil is wider than the other, this is a cause for concern and see a doctor. This often means a serious pathology, potentially life-threatening. Anisocoria in case of head injury is a deadly symptom and indicates a wedging of the trunk.

Types of anisocoria

Depending on the degree of damage, the pathology can be unilateral or bilateral. Affecting both eyes is quite rare.

If one pupil is larger than the other, you should consult an ophthalmologist

Causes

The causes of anisocoria can be very different. Different pupil sizes may be a consequence of ophthalmological factors, namely:

uveitis;
iritis;
iridocyclitis;
lens implantation;
surgery on the eye.

Pupils of different sizes can also occur due to other reasons:

cerebral aneurysms;
traumatic brain injury;
pathologies of the oculomotor nerve;
migraine;
hemorrhages;
infectious processes;
genetic predisposition;
cervical osteochondrosis;
syphilis;
epidemic encephalitis;
stroke;
tumor process;
glaucoma;
taking certain medications;
cerebrovascular accidents;
herpes zoster.

When should you see a doctor?

If one pupil has become wider and this condition does not go away, and it cannot be explained, be sure to consult an ophthalmologist. You should be especially wary of the following symptoms:

blurred vision;
fever;
photosensitivity;
double vision;
Pain in the eyes;
headache;
disturbance of consciousness;
temperature increase;
attack of nausea and vomiting.

If you notice that your pupils are different sizes, do not hesitate to consult a doctor.

Diseases that cause changes in the pupil

Let's talk about pathologies, one of the symptoms of which is anisocoria. First, let's discuss paresis of the oculomotor nerve.

The following reasons can cause nerve paresis:

cervical osteochondrosis;
diabetes;
hypertension;
vasculitis;
carotid artery aneurysm;
tumor process;
heart attack;
stroke;
syphilis, diphtheria, encephalitis, meningitis;
side effects of medications;
injuries;
ocular migraine.

Paresis of the oculomotor nerve is one of the causes of anisocoria

Full restoration of nerve mobility occurs after about six months. If there is no result, surgery may be required.

Bernard Horner syndrome

damage to brain tissue;
cluster headache;
injuries, including surgical ones;
otitis media;
aortic aneurysm.

In Bernard Horner syndrome, the pupil constricts in bright light and dilates in the dark

Problem areas can also be corrected using plastic surgery. Stimulation of affected facial tissues is also possible with the help of drug therapy.

Eydie syndrome

The disease can be congenital or acquired. The cause of Eydie syndrome can be ophthalmoherpes, atrophy of the eye muscles, meningitis, encephalitis, myotonia.

Treatment includes the use of Polycarpine. Regular use of these drops will help to achieve some improvement in the condition. Glasses are used to correct violations.

Anisocoria in children

brain contusion;
tumor process;
aneurysm;
encephalitis.

At an older age, one pupil larger than the other may appear for the following reasons:

injuries;
cerebral edema;
inflammation of the iris;
ophthalmic injuries;
intoxication;
aneurysm;
tumor;
overdose of medications.

In a child, one pupil larger than the other is most often the result of birth defects

Diagnostics

An ophthalmologist diagnoses anisocoria. To clarify the reasons for this phenomenon, the following studies will be required:

ophthalmoscopy;
measurement of intraocular pressure;
electroencephalography;
Brain MRI;
X-ray of the lungs;
cerebrospinal fluid analysis;
Dopplerography of the blood vessels of the brain.

The photo shows the process of eye ophthalmoscopy

Treatment

Pupils of different sizes may be a manifestation of an ophthalmological or neurological disease.

This pathology is also called anisocoria, as can be seen in the photo, while a person has pupils of different diameters. Typically, one eye reacts to light while the other remains motionless. The difference in the diameter of the two pupils is considered to be no more than 1 mm. Outwardly it is absolutely invisible.

Types of anisocoria

physiological. If the difference between the pupils is 0.5-1 mm and the diagnosis did not reveal any diseases, then this condition refers to physiological anisocoria and is regarded as an individual characteristic of the body. According to statistics, this feature occurs in one fifth of people.
congenital. This type develops due to defects in the visual apparatus, and the eyes may have different visual acuity. Also, the causes may be impaired development or damage to the nervous system of the eyes.

Anisocoria in a child

Sometimes a child is born in a family with different pupils; if one of the relatives had similar deviations, then most likely it is genetic and there is no reason to worry.

Parasympathetic denervation (pupils of different sizes) occurs due to infectious inflammation of the eyes or injury to the orbit of the ciliary ganglion.
In this case, the pupil does not react to light, but the slow ability to accommodate (adapt) remains.

Eydie and Horner syndromes

Eydie's syndrome is characterized by the fact that when the gaze moves into the distance, the pupil dilates slowly, and this, in turn, disrupts accommodation and is lost. This syndrome is often observed in young women and is the cause of mydriasis in one eye.
If anisocoria intensifies in the dark or when light is removed, then this is a manifestation of simple anisocoria or Horner's syndrome.

This syndrome is accompanied by ptosis, facial anhidrosis (impaired sweating) and pupil constriction, and is often a consequence of impaired sympathetic innervation of the eyes. The pupils of Horner's syndrome respond normally to accommodation and light.

The cause of Horner's syndrome is cancer of the upper part of the lung, damage to the spinal cord or upper cervical spine. With Horner's syndrome, which arose from cancer of the upper part of the lung, at the same time there is a loss of pain in the small muscles, radiating to the medial surface of the arms.

Pupils of different sizes occur as a result of compression of sympathetic fibers due to thyroid cancer, due to various surgical interventions, injuries, tumors, enlarged lymph nodes in the neck, thrombosis of the carotid artery and for other reasons.

If the carotid artery is dissected as a result of injury, Horner's syndrome is accompanied by facial pain on the same side and cerebrovascular accidents.

Horner's syndrome in children is caused by neuroblastoma in the cervical or upper thoracic region.

With simple anisocoria (essential), a small difference in the size of the pupils (no more than 0.5 mm) is often diagnosed.

A migraine attack is sometimes caused by unilateral mydriasis. In this case, pupils of different sizes do not last long and pupil reactions are completely preserved.

MRI (Magnetic resonance imaging);
X-ray of the cervical spine and head;
The list of studies is not long enough, but as we see, it includes such examinations as MRI, puncture of the spinal canal (studies of cerebrospinal fluid), and these are very specific studies, especially puncture, which not all specialists do. Therefore, it is impossible to determine the cause by eye, as “well-wishers” often do, and it is also impossible to prescribe treatment.
Finally
Drawing a line under everything written above, the conclusion suggests itself, in order to preserve the health of both the body as a whole and the eyes, firstly, you should not neglect visiting a doctor, and secondly, do not listen to the opinions of people who are far from medicine. Thirdly, undergo examination by a number of specialists, and not just by an ophthalmologist.
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The pupils are normally symmetrical, and very minor deviations are also allowed, up to one millimeter. If the size of the pupils varies significantly, this may indicate anisocoria.

When the pupils are different, regardless of the lighting, or this is due to physiological reasons, then anisocoria is not a problematic disease. In cases where the size changes noticeably, pathological anisocoria is most often diagnosed and needs to be treated.

Anisocoria is a condition in which the pupils of the eyes differ in size or diameter.

The pupil is the black area in the center of the iris. Depending on the lighting, it can change its size (from one to six millimeters).

Many factors can affect pupil size. For example, heredity. If one of the family members had anisocoria, then it is possible that it will be inherited. In this case, the pathology does not cause harm and no treatment is required. When exposed to light, the pupils contract, and if the muscles work incorrectly, external signs of anisocoria appear. Various drops and eye medications affect the size of the pupils. Also, the reasons may be damage to the optic nerve or post-traumatic changes and brain damage.

If there is any pathology, then anisocoria can be supplemented by such manifestations as:

Limited movement of the eye or both eyes.

Ptosis ().

High temperature, febrile state.

Headaches, nausea, vomiting.

Double vision of objects.

If these symptoms appear, you should immediately consult an ophthalmologist so as not to worsen the situation and prevent the occurrence of more serious problems.

Anisocoria has three types. It can be physiological, congenital and pathological.

Physiological Anisocoria is the fact that many people's pupils are normally different sizes.

Congenital Anisocoria occurs due to the presence of defects in the visual apparatus, developmental disorders or damage to the nervous system.

Pathological Anisocoria is associated with various eye diseases, for example, tumors, as well as general diseases, for example, brain tumors, migraines, syphilis, and so on.

Causes

The causes of anisocoria may vary depending on the age of the person.

In children, this pathology is often associated with genetic abnormalities. So in this case there is no reason to worry. This hereditary feature appears immediately after the birth of a child and does not lead to developmental delays. Most often, pupil size becomes the same at age five or six, but sometimes differences can persist throughout life.

Sometimes a difference in pupil size can be a manifestation of Horner's syndrome, then ptosis is connected to anisocoria.

In newborns, the causes of anisocoria may be developmental disorders of the autonomic nervous system or hereditary pathology of the iris. If it appears suddenly, it may be a sign of a tumor or aneurysm of the brain vessels, brain contusion or encephalitis.

Causes of anisocoria in adulthood:

Brain aneurysm.

Traumatic brain injuries, bleeding.

Diseases of the oculomotor nerve.

Migraine.

Tumors, brain abscess.

Infectious diseases (encephalitis, meningitis).

Inflammatory eye diseases (uveitis).

Glaucoma.

Medications.

Horner's syndrome(a tumor in the lymph node located at the top of the chest).

Roque's syndrome (occurs due to lung cancer).

Injuries to the eye with damage to the muscles responsible for the constriction and dilation of the pupil.

Cerebral circulation disorders.

Hereditary developmental disorders of the visual organs.

Possible diseases

Different pupil sizes may indicate the following diseases:

Iritis– inflammatory disease of the iris.

Infectious eye diseases.

Eye injuries.

Horner's syndrome– increased anisocoria when in the dark or when the light source is removed.

Eydie syndrome– slow reaction of the pupil during eye movement, leading to i.

Migraine attacks, which cause one-sided mydriasis.

Thyroid cancer, which develops due to injuries, tumors, surgical interventions, thrombosis of the carotid artery, enlarged lymph nodes in the neck, and so on.

All these diseases require treatment. If signs of anisocoria appear, you must consult a specialist.

The treatment method for anisocoria depends on the underlying diagnosis. For example, for ophthalmic diseases, antibacterial and anti-inflammatory drugs are prescribed, as well as anticholinergic substances that relieve spasm of the iris muscles and dilate the pupil.

Diagnostic methods

Diagnosis of anisocoria includes the following methods:

Anamnesis collection. This includes information about the appearance of the first signs of anisocoria, eye injuries, syphilis, and the use of various eye drops and ointments.

Eye examination. The doctor determines which pupil is the wrong size. If there is a problem in determining which pupil is pathological, then their sizes in the light and in the dark are compared. Anisocoria, which is more pronounced in the light, indicates that the pupil is abnormally wide, and anisocoria, which is more pronounced in the dark, indicates that the pupil is abnormally small. The specialist should also check the reaction of the pupil to light and the reaction to convergence in case of a pathological reaction to light. An examination is carried out to detect ptosis, the movement of the eyeball is determined and the edge of the pupil is examined using a slit lamp.

Pharmacological tests. Solutions of tropicamide and pilocarpine are dripped into the eyes, which allows preliminary conclusions to be drawn about the presence of Horner's syndrome or Eydie's syndrome.

If anisocoria is caused by any disease of the central nervous system or vascular disorders, then consultation and examination by a neurologist is necessary. The doctor may prescribe an MRI, CT scan, X-ray of the neck and skull, spinal tap, and so on.

Prevention

Prevention of anisocoria includes:

Timely visit to a neurologist or ophthalmologist when the first symptoms of anisocoria appear.

Cholesterol level control and correction.

Blood pressure control.

Controlling blood sugar levels.

It should be noted that there is no method that would guarantee protection against changes in pupil size. But these preventive measures will help reduce the risk of developing pathology if taken in a timely manner.

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conclusions

Anisocoria in most cases is an acquired condition, which is caused by damage to the ciliary muscle. It may be associated with pathological diseases or dysfunction of the nervous system. Therefore, it is necessary to diagnose the underlying disease as accurately as possible.

With proper treatment of the underlying disease, anisocoria disappears completely. And congenital eye pathologies, which can cause different pupil sizes, are successfully treated with surgery.

A description of the drug Diclofenac (eye drops) can be found. We also recommend that you familiarize yourself with Dex-Gentamicin drops.

Anisocoria is an abnormal process that is caused by differences in pupil size. That is, when the pupil on one eye is smaller than on the other. In addition, the pupil reacts poorly or not at all to light rays, and may have deformed contours.

Pupils of different sizes do not always indicate the presence of a serious disease in the body. According to medical standards, a difference in size of up to 1 mm is considered within normal limits, provided there are no complaints or other symptoms. Inequality of pupils of more than 1 mm in an adult may indicate: abnormalities or pathology of the brain, visceral and nervous disorders, eye diseases, etc.

The gift of vision makes it possible to enjoy the beauty of the world around us and greatly simplifies life. It is recommended to stop any reasons that lead to a decrease in the quality of vision at the initial stage of their development. Some diseases can not only deprive a person of the ability to see, but also threaten life.

Deviation from the norm can be caused by damage to the muscles that constrict and dilate the pupil. Other root causes that make one pupil larger than the other include:

Heredity. This anomaly can be inherited. In most cases, hereditary anisocoria is observed only in childhood. As you grow older, this abnormal phenomenon disappears on its own.

Injury or eyes.

Infectious diseases.

The presence of aneurysms or tumors that compress the optic nerve.

Angle-closure glaucoma.

Diseases of the iris.

Neurological abnormalities.

Disruption of normal blood circulation in the brain.

Hemorrhage.

Medications.

Narcotic substances. The action of some drugs can dilate or contract the pupil for a certain period of time. Under the influence of such drugs, sensitivity to light disappears.

Paresis or paralysis of the oculomotor nerve (Horner's syndrome).

Enlarged lymph nodes in the neck.

Malignant or benign neoplasms in the orbit.

Thrombosis of the carotid artery.

Inequality of pupils in Eydie syndrome is characterized by the fact that when looking into the distance, one pupil immediately becomes wider, and the second expands slowly.

Examination of the patient for pathology

If the right pupil is wider than the left, or vice versa - the left is wider than the right, it is recommended not to delay a visit to the ophthalmologist. After interviewing the patient, examining him and checking his vision, the ophthalmologist makes a final diagnosis. Based on this, appropriate treatment is selected. In some cases, an examination by an ophthalmologist will not be enough.

To determine the true cause that provoked anisocoria, the patient is prescribed additional tests.

During the examination, the doctor pays attention to:

dynamics of pupil contraction;

contraction symmetry;

determination of size in light and in darkness.

When a patient has pupils of different sizes, the one that reacts incorrectly to lighting is considered pathological. In the dark, the pupils should dilate. The eye in which the pupil is dilated is considered healthy. In bright light, a dilated pupil is considered an anomaly.

Additional symptoms such as pain, double vision or ptosis help make the correct diagnosis.

A pharmacological eye examination test helps determine the presence of Horner's syndrome. In order to carry out the test, a 5% solution of cocaine or 1 solution of apraclonidine is instilled into the eyes. After such eye drops, the pupils should dilate evenly. If the patient has damage to the oculomotor nerve, the pupil becomes no more than 1.5 mm wider.

To test the third neuron of the sympathetic system, a 1% solution of phenylephrine or tropicamide is instilled into the eyes. A deviation from the norm is considered if the pupil is dilated whiter than 1.3 mm.

Anisocoria can be checked using a weak pilocarpine solution. Such drops do not affect the sensitivity of the pupils if there is no pathology.

During pharmacological testing in adults, the content of the active substance in the solution is higher than in those drops used to test pupil dilation in children.

To refute or confirm the presence of an aneurysm or tumor, magnetic resonance imaging (MRI) or multislice computed tomography (MSCT) is recommended.

How to get rid of anisocoria

When a person has different sized pupils due to heredity, treatment is not necessary. If the patient is not satisfied with the fact that his right pupil is smaller than the left (or vice versa) and he wants to get rid of this feature, the difference in pupil sizes can be corrected using ophthalmological surgery. An alternative to surgery is special eye drops, but their constant use can cause irritation of the mucous membrane of the eye. Treatment of anisocoria is also not carried out if no concomitant pathologies were identified after a diagnostic examination. In this situation, anisocoria is not regarded as a disease, but is considered an individual characteristic of the patient.

In all other cases, it is necessary to treat the underlying disease that makes one pupil larger than the other.

Drug treatment is carried out using the following drugs:

antibacterial;

anti-inflammatory;

corticosteroids.

Trying to get rid of anisocoria on your own using folk remedies is impractical and dangerous. For many diseases that manifest themselves as symptoms such as pupil inequality,