![]() How does the doctor determine whether anisocoria is due to an underlying medical problem?Ĭertain signs, such as when the anisocoria was first noted, whether it is more noticeable in bright or dim light, and whether there was an event that happened in the past that could have caused it, will help the ophthalmologist understand the cause. For example if there is a one millimeter difference in the size of the pupils in bright light, there will be a one millimeter difference in size in dim light as well. In physiologic anisocoria, the difference in pupil size does not usually change under bright or dim light. Typically, with physiologic anisocoria, the difference in pupil size between the two eyes is small, about one millimeter or less. Anisocoria that is NOT caused by a medical problem is called physiologic anisocoria. The amount of anisocoria can be different from day-to-day and can even switch eyes. Up to 30% of people have anisocoria and it is normal for them. Anisocoria can be normal (physiologic), or it can be a sign of a medical problem. The term anisocoria means that the pupils are not the same size at the same time. Normally pupils are in the same size, with both eyes dilating or constricting together. Is it normal to have pupils of different sizes? In the center, the dark spot is a hole in the iris called the pupil. 1: The iris is the colored part of the eye. When in a dark room the pupil usually gets bigger (or dilates) to allow more light to enter the eye. When in a bright room or in sunlight, the pupil usually gets smaller (or constricts). The size of the pupil depends on how much the iris muscle is constricted (tightened). The empty hole in the middle, which allows light to enter the eye, is called the pupil. ![]() It is a round muscle, similar in shape to a donut. KEYWORDS: Adie tonic pupil, cholinergic supersensitivity, transient parasympathetic dysfunction, unilateral mydriasis, RAPD.The colored part of the eye is called the iris. The importance of timely referral to neurologist must be borne in mind always in such cases. Thorough history and basic clinical neurological examination are mandatory. Demonstration of probable transient parasympathetic dysfunction suggests that pharmacologic testing with dilute pilocarpine should be considered in patients reporting with near vision problems with isolated unilateral recent onset mydriasis which is probably intermittent. Our cases raise several important question regarding so-called "benign pupillary dilation of the young" and its relationship with Adie's tonic pupil. The 3rd patient was a 45 year old presbyope who presented with sudden drop in near vision in one eye. 2 of the patients with mydriasis were younger, 32 & 35 years of age, presenting with recent onset of blurring of Vision for distance and difficulty in reading. The short history poses a diagnostic dilemma as to whether it is Adie's Tonic pupil or a harbinger of a serious neurological problem. We report 3 cases of acquired mydriasis, with cholinergic supersensitivity. A keen observational and clinical skill can help the ophthalmologist in diagnosis & timely referral when necessary. These diseases may range from vision threatening to life endangering to innocuous ones. ![]() ![]() It often causes confusion as they can be manifestations of local and/ or systemic diseases. Abstract : Pupillary abnormalities are a common feature of general ophthalmic practice. ![]()
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