![]() I would like to go ahead with the laser surgery and decided to go with a different doctor after all. The doctor suggested I should see a neuro-ophthalmologist, even though he thought it is probably nothing serious and he said it is likely could not be fixed. The doctor said both eyes looked healthy and they constrict and dilate symmetrically in low and bright light condition.(to clarify : changing % of pupil surface is the same, even though they are different in size). ![]() ![]() I brought up the size difference in my pupils during my preop exam. I’ve had it probably for a year already.Recently I decided to do a PRK vision correction surgery. I noticed that my left pupil is larger than the right one. Horner’s syndrome is important to diagnosis, because it can indicate a lesion in the brain stem ( stroke), neck ( carotid artery dissection) or lung apex ( Pancoast’s tumor). Furthermore, there is usually an associated lid ptosis and facial hypohidrosis. Horner’s syndrome causes unilateral miosis, and the affected abnormal pupil either does not dilate or has a delayed dilation in the dark. ![]() Physiologic anisocoria is mild (usually less than 0.5 mm difference in size between the pupils, and the amplitude of the difference does not vary greatly under dim or bright light conditions. If the smaller of the pupils is abnormal, a miosis, then the anisocoria will be more apparent (the affected pupil will be smaller) in dull ambient light conditions (a dark room), and less apparent (the pupils will be more equal) in bright light.Īlternatively, if the large pupil is the abnormal side, mydriasis, it will fail to contract in response to intense light.Ī unilateral miosis can be physiologic or can indicates a lesion affecting the sympathetic nerve fibers to the eye known as Horner’s syndrome. The first step in evaluating anisocoria is to determine which is the abnormal side – this can be accomplished by comparing the pupil sizes in response to bright light and dull ambient light: Anisocoria – the pupils are unequal, is the the pupil too large, or is the left pupil too small? ![]()
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