Different pupils in the eyes. What to do with pupils of different sizes? Anisocoria as a symptom of the disease

In ophthalmology, there are various eye pathologies, and some of them may indicate that a person has more serious diseases that can not only cause irreparable harm to health, but also threaten a person’s life.

These pathological conditions are different pupils in size in an adult person. There are various reasons for the appearance of such a condition, in some cases there is no cause for concern, but there are also those when a visit to a doctor should be immediate. Among such causes are eye and head injuries, tumors, and infections.

Cases When You Shouldn't Worry

What is characteristic of the majority is considered normal, and what is beyond the normal is considered pathology, but this is not always a pathology. We are all used to the fact that the pupils are symmetrical and have the same size, but do not forget that all people are different and in some cases this is just an individual feature. It is also worth remembering that there are no absolutely symmetrical pupils.

Sometimes, even very often, there is a situation where the eyes are simply set differently. Visually, this is not noticeable at all, but it concerns the landing depth, since the difference in most cases is minimal and amounts to 1 mm, and sometimes much less, some fractions of millimeters. But in order for the pupils to appear to be of different sizes, it is quite enough.

Also, do not forget the fact that a difference of 1 mm for an adult is considered normal. Of course, with a more significant deviation, it is worth contacting a specialist.

What is Anisocoria and what causes it?

Experts identify several main reasons due to which there are different pupils in size in an adult. The simplest reason Why do pupils vary in size in adults? The most common is heredity. It is quite possible that someone in the family already had Anisocoria. If the cause is heredity, then there is no cause for concern and treatment is not required in this case.

Another reason is a dysfunction of the muscles of the eye, which is noticeable in the light, when the rays of light affect the eyes.

Anisocoria can also occur:

When instilled with eye drops;
- when using certain medicines, such as asthma medicines;
- in violation of muscle innervation, as a result of damage to the optic nerve.

But these are quite harmless reasons, but there are also very serious ones, one of which is brain damage.

Same way causes of anisocoria in adults, can be:

The development of tumors in the brain;
- bruises and injuries;
- aneurysm;
- damage to the cervical vertebrae;
- muscle atrophy and much more.

Such a phenomenon may be temporary, but in the case when it persists for a long period of time, it is worth contacting doctors, not just one, but several at once to examine the whole body and make the correct diagnosis.

Diagnostics

Timely and correct diagnosis is the key to successful treatment of diseases and pathological conditions of the eye. Do not self-medicate or resort to the advice of friends and relatives and use various traditional medicines.

Analyzes and examination methods for the diagnosis of Anisocoria:

KLA (general blood test);
- CT scan;
- MRI (Magnetic Resonance Imaging);
- X-ray of the neck and head;
- research of cerebrospinal fluid.

The list of studies is not large enough, but as you can see, it includes such examinations as MRI, puncture of the spinal canal (studies of cerebrospinal fluid), and these are very specific studies, especially puncture, not all specialists do it. Therefore, it is impossible to determine the cause by eye, as “well-wishers” often do, just as it is impossible to prescribe treatment.

Finally

Summing up everything written above, the conclusion suggests itself, in order to maintain the health of both the body as a whole and the eyes, firstly, do not neglect going to the doctor, and secondly, do not listen to the opinion of people far from medicine. Thirdly, to be examined by a number of specialists, and not just by an ophthalmologist.

Anisocoria is a condition in which the pupils of the right and left eyes differ in size or diameter. The pupil is the round black area in the center of the iris. Depending on the lighting, it can have dimensions from 1mm to 6mm in diameter.

In the presence of a general or ocular pathology, anisocoria is always combined with the following manifestations:

• restriction of eye movement, or an eye in which the pupil is larger
• drooping of the upper eyelid (ptosis)
• Pain in the eyes
• fever or fever
• headache
• decreased vision
• double vision

Causes of anisocoria

There are two types of anisocoria:

• physiological. Normally, every fifth person has a slight difference in the size of the pupils.
• pathological. Eye diseases that can lead to anisocria: glaucoma, inflammatory diseases of the eye (iritis, uveitis), eye tumors
• pathological in general human diseases: viral infection, syphilis, brain tumors, cranial nerve palsy, Horner's syndrome, migraine, brain aneurysm.

When should you urgently see a doctor?

Anisocoria can be a sign of very serious medical conditions that require emergency medical attention.

Therefore, consult a doctor if you experience the following symptoms:

• temperature rise
• Strong headache
• nausea and dizziness
• double vision
• drooping and swelling of the upper eyelid

If you have suffered a head injury and the pupils of your eyes have become of different sizes, be sure to consult a doctor.

How to treat anisocoria

Physiological anisocoria does not affect vision and eye health. Therefore, it does not need treatment.

In pathological anisocoria, the cause of the appearance of different pupils is first identified. Then the treatment is carried out.

For example, with a brain infection, treatment is carried out in a specialized hospital. A course of antibiotics and antiviral drugs is prescribed.

Head tumors and aneurysms of the vessels of the head require surgical treatment.

With glaucoma, treatment is carried out aimed at normalizing eye pressure and preventing the development of glaucoma attacks.

Inflammatory diseases of the eye are treated with antibiotics.

Surgical treatment is indicated for eye tumors.

What absolutely should not be done with anisocoria

When a symptom of different pupils appears, you should not:

• instill drops on your own, which can affect the size of the pupils

What happens if the symptom of anisocoria is not treated

In the case of physiological anisocoria, treatment of the symptom is not required.

The presence of pathological anisocoria indicates serious diseases of the eyes or head. Therefore, if the cause is not identified and treatment is started on time, serious complications and the development of conditions that threaten the life of the patient are possible.

Prevention of anisocoria

There are no specific measures to prevent anisocoria. However, you can reduce your risk of developing this condition by using protective equipment when playing contact sports.

In the presence of neurological and ophthalmic diseases, the patient may experience pupils of different sizes. Such a symptom, which is characterized by an unequal size of the eye pupils, is called anisocoria in medicine. As a rule, one eye reacts to light, while the other remains motionless. It is considered normal to consider the difference in the diameter of two pupils no more than 1 mm. Outwardly, such a difference is completely imperceptible.

Causes

• If a disease like anisocoria occurs as a result of an eye injury, due to which the muscle that narrows the pupil is damaged, then immediately after this injury, the pupil first narrows, but then it expands again, ceasing to respond to accommodation and light stimuli.
• Pupils of different sizes often provoke inflammation of the iris, the so-called iritis All pupil reactions are blunted in angle-closure glaucoma due to iris ischemia. Glaucoma is accompanied by palpable acute pain in the eyeball, a person's vision gradually decreases.
• If pupils of different sizes are more visible in bright light, then this is most likely a manifestation of parasympathetic innervation disorders. This disease causes pupil dilation ( mydriasis), and all his reactions are also weakened. Most often, mydriasis is a consequence of damage to the oculomotor nerve, which is accompanied by a divergent strabismus, limitation of motor functions of the eyeball, and doubling.
• Different pupils in anisocoria may be the result of a tumor or an aneurysm compressing the oculomotor nerve. Parasympathetic denervation (pupils of different sizes) is possible as a result of infectious inflammation of the eyes or trauma in the orbit of the ciliary ganglion. In this case, the pupil does not react to light, but there is still a delayed ability to accommodate (adaptation).

Read more about what mydriasis is at.

Anisocoria can occur in a person for various reasons. However, its manifestation is also not always the same.

Possible diseases with anisocoria

Some people are afraid that the different color of the iris of the eyes may be the cause of this disease. However, these are just empty prejudices. This rare disease can be caused by the following diseases or symptoms:

• Aneurysm of the brain.
• Traumatic brain injury and concomitant bleeding.
• Diseases of the oculomotor nerve.
• Migraine, in this case, the difference in the diameter of the pupils does not remain long.
• Neoplasm or abscess of the brain.
• Various infectious processes in the brain (encephalitis, meningitis).
• there may be increased pressure in one of the eyes.
• The use of certain drugs, such as eye drops, can cause a reversible difference in pupil size.
• Horner's syndrome. A neoplasm in the lymph node, which is located at the top of the chest, can cause severe anisocoria, as well as
• Roque's syndrome is the cause of lung cancer.
• with damage to the muscles responsible for the constriction and expansion of the pupil.
• Disorder of cerebral circulation.
• Thrombi in the carotid artery.
• Inflammatory diseases of the eyes (,).
• Hereditary anomalies in the development of the visual organs.

Anisocoria can be the result of dangerous diseases that can cause serious harm to a person.

Methods for diagnosing this disease

For diagnostic methods for detecting anisocoria, the doctor, first of all, determines which particular eye does not respond to the difference in lighting conditions, because we can talk about both the inability to narrow and the inability to expand. The doctor prepares information regarding the accompanying problems that are associated with vision: clarifies whether there is pain in the eyes. This is followed by a series of mandatory procedures:

• Taking a blood test.
• Skull tomography.
• Magnetic resonance imaging.
• Ultrasound procedure.
• Angiography.
• Monitoring of indicators of a blood pressure.
• X-ray examination of the cervical region and skull.
• Analysis of cerebrospinal fluid.

What is an eye colomba read.

Angiography and ultrasound are prescribed for suspected vascular anomalies. The doctor may also ask the patient to bring in old portrait photographs of the patient, in order to be able to make sure that the problem has not been noticed before.

Treatment of anisocoria

The treatment of this disease depends entirely on the identified cause of the pathology. If this is a hereditary or physiological condition, then there is no need for treatment. If the cause is infectious or inflammatory processes, then treatment for a suitable nosology can be prescribed. Topical or systemic antibiotics are used. In case of tumor processes, surgical intervention is required. Due to the fact that the reasons for different pupil diameters can be very different and can be of a different nature, it is better not to postpone a visit to a specialist.

And also about visual scotoma.

Disease prevention

conclusions

So, pupils of different diameters is a disease that can be both pathological and acquired. The causes of anisocoria can be various manifestations of dangerous diseases. At the first signs of this disease, you should not postpone a visit to the doctor and self-medicate.

Anisocoria is a common ophthalmic abnormality in which the patient's pupil sizes do not match. In this case, the changed pupil may be slightly deformed. If one pupil is larger than the other, the causes of this pathology in adults can be different, ranging from hormonal failure to a serious eye disease. It is quite simple to determine the pathology: you just need to focus your eyes on some object in front of the mirror, which is in a stationary state. In this case, one pupil will constantly change its size, expanding or narrowing, while the other, on the contrary, will remain motionless. With the presence of a problem, everything is clear, now you need to start treatment.

According to statistics, anisocoria is most often diagnosed in childhood, but adults also often have to deal with it. Read more about the causes and treatment of the disease and will be discussed in this article.

How pupils work

This is the key component of the eye, located in the center of the iris. The main task of the pupils is to collect light rays, which they then perceive. Around the pupils are muscles that, by contracting, regulate the illumination of the retina. For example, when a person enters a dark room, his pupils dilate to capture light, and in a brighter room, the pupils constrict accordingly.

This is an important system that allows you to get the maximum amount of information from the environment in different lighting conditions. But in case of violation of the functions of the pupils, serious problems can arise. The degree of illumination in the room is not the only reason for the change in the size of the pupils.

On a note! A similar phenomenon can also be observed under the influence of uniform illumination, therefore, a slight difference (no more than 1 mm) may occur between the diameters of the pupils. This indicator is the norm, and if the difference is exceeded, the help of a specialist is necessary.

Causes of the pathological condition

As noted earlier, anisocoria can develop in people regardless of their age or gender. But there are many factors that can cause this disorder, and all of them may differ depending on whether it is a child or an adult patient. If in newborns a developmental deviation or genetic predisposition can provoke an ailment, then in infants anisocoria develops against the background of food poisoning, encephalitis, brain injury, oncological diseases or aneurysms.

Now consider the main causes of anisocoria in adults:

• severe migraine;
• inflammatory eye diseases (iridocyclitis, keratitis and others);
• the consequences of the use of certain medications, for example, "Atropine";
• infectious diseases (encephalitis, meningitis, etc.);
• mechanical damage to the organs of vision resulting from trauma;
• intracerebral hemorrhage;
• Horner's syndrome;
• development of benign or malignant tumors.

It is impossible to exclude such a factor as a genetic predisposition, because anisocoria refers to those diseases that can be inherited. Therefore, if one of your parents or relatives has previously encountered this disease, then it is likely that after some time you will be diagnosed with it.

Additional symptoms

Along with a change in the size of the pupil, the patient may experience other symptoms, including:

• decrease in working capacity;
• blurred vision;
• development of torticollis (a pathology accompanied by a change in the nerves, skeleton and soft tissues of the neck);
• bouts of nausea and vomiting;
• pain in the eye area;
• feverish state;
• Strong headache;
• in the eyes begins;
• increased sensitivity to light;
• blurred vision.

If these symptoms appear, you should immediately seek medical help. Only a timely appeal to a specialist will eliminate the problem at an early stage of development, which will eliminate the likelihood of serious complications.

Features of diagnostics

You need to contact an ophthalmologist who will conduct a neurological and physical examination of the patient. As a rule, when diagnosing anisocoria, the doctor prescribes the following procedures:

• checking the reaction of pupils in a light and dark room;
• X-ray examination of the cervical region or skull;
• if glaucoma is suspected, the patient is given tonometry;
• magnetic resonance imaging (MRI);
• laboratory analysis of cerebrospinal fluid;
• analysis of urine and blood.

On a note! Based on the results of the tests, the doctor can make a diagnosis. Only after establishing the exact cause of the pathological condition, the patient is prescribed a course of appropriate therapy.

How to treat

Depending on which factor provoked the development of this deviation, the course of treatment may vary. Let us consider in more detail the principle of treatment of anisocoria in accordance with the causative factor.

Table. Features of the treatment of anisocoria in adults.

In almost all cases, they indicate the course of a serious illness that requires immediate treatment. Therefore, it is impossible to ignore the symptom, because it is fraught with serious consequences.

Is it possible to change pupil size?

Many people wonder if it is possible to influence the size of their pupils on command. For example, you need to narrow or expand the pupils for the duration of the photo shoot. In fact, there is nothing difficult in this. Below is a step-by-step instruction, following which will lead you to the desired result.

Step 1. Enter a dark room. As noted earlier, pupils dilate in a dark room as they try to “catch” more light. If it is not possible to completely remove the light in the room, then simply turn away from the windows, thereby protecting yourself from light sources.

Step 2 To narrow your pupils, turn to a light source in your home and stay in that position for a few seconds. If you are on the street, then it is enough to look up. Of course, looking at the sun is bad for your eyes, so it's best to focus your eyes on something else.

Step 3 Another easy way to narrow your pupils. Just look at the object that is located next to you. When focusing, the pupils constrict. Alternatively, you can put your finger in front of the eye and focus your attention on it.

Step 4 Tighten your abdominal muscles. Many people manage to dilate the pupils by keeping the muscles in constant tension. To test this method, you need to tighten your stomach and look at yourself in the mirror. If the pupils are dilated, then this method is suitable for you, if not, then try another method.

Prevention measures

To prevent the development of anisocoria, it is necessary to take certain preventive measures:

• regularly donate blood to check the level of sugar;
• monitor changes in blood pressure;
• Check your blood cholesterol levels and adjust if needed. This will prevent the development of such a disease as atherosclerosis;
• regularly conduct preventive examinations with doctors to identify possible violations at an early stage of development. It is not only about the ophthalmologist, but also about other doctors.

Different pupil diameter or anisocoria is a serious pathological disorder that may be associated with the development of various diseases or abnormalities in the body. Therefore, in order to avoid complications, it is necessary to identify the cause of the pathology as soon as possible, especially since anisocoria in rare cases can act as the only symptom of the disease.

Video - What do eyes of different sizes mean

The free edge of the iris of the eye forms a physiological opening for the passage of a light beam. Black staining provides a mesh shell. By changing the diameter of the aperture, the amount of transmitted light is regulated.

For clear images in bright light, constricting the pupil of the eye prevents glare from reaching the retina. In low light, the reverse process occurs. Pain and a feeling of fear reflexively expand the opening of the iris.

In the article, we will consider the causes of different pupils in size in an adult and a child, as well as ways to treat anisocoria.

Anisocoria refers to one of the symptoms that signal damage to the motor nerve fibers of the oculomotor nerve. The pupil of the affected eye is immobilized and may be deformed. ICD 10 code - H57.0.

In a healthy eye, the reactionary constriction and expansion of the pupil is not disturbed. Normally, in humans, the size of the pupils does not differ significantly. In cases where the difference becomes noticeable, a number of deviations can be suspected.

Why are pupils of different sizes in humans?

What diseases can this be

Anisocoria occurs as a result of intrauterine development. The acquired form of the disease develops due to disorders of the nervous system. Ocular anisocoria indicates pathological processes in the eye itself. The most common symptom is unilateral.

Congenital types of anisocoria occur against the background of eye anomalies. Damage to the muscle fibers of the eye or their innervation causes an inadequate or delayed pupillary response to light. Changes in the central nervous system are manifested, in addition to the difference in pupils, by strabismus. The cause of acquired anisocoria may be traumatic lesions or eye diseases.

Deviations in anisocoria are accompanied by a narrowing or expansion of the damaged eye. The factors for the occurrence of the anomaly in the two cases are different.

Pathological narrowing of the pupil occurs when:

• instillation of eye drops containing miotics (pilocarpine) in one eye;
• the development of iritis or iridocyclitis, accompanied by eye pain, redness of the eye and the formation of flakes of the anterior eye chamber;
• exposure to cocaine;
• If the eye is affected by treponema pallidum, the shape of the pupil is uneven with moderate anisocoria and intermittent reactions to light.

Pathological narrowing is observed in the following cases:

• traumatic rupture of the sphincter of the iris;
• Adi's abnormal pupil with irregular shape and minor reactions to specific stimuli;
• paralysis of the third cranial nerve and the development of muscle paralysis with a lowered eyelid;
• unilateral dilatation with atropine.

Often this phenomenon can be observed with traumatic brain injury (TBI), as well as a stroke.

Diagnostics

In order to make a diagnosis of anisocoria, doctors have to study in detail the neurological and physiological status of the patient. The complex of diagnostic studies consists of:

• analysis of venous and capillary blood;
• liquor research;
• computed tomography of the skull;
• magnetic resonance imaging;
• blood pressure measurements;
• radiographs of the skull and cervical spine.

You will need to undergo a neurological examination.

What to do if the pupils are of different sizes

If the difference in the size of the pupils exceeds 2 mm, it is necessary to contact an experienced neurologist to determine the cause of the pathological condition. There is no unified treatment plan for anisocoria, since there are so many factors for its development. It is necessary to direct conservative methods to the underlying disease.

If necessary, resort to the surgical method. Drug treatment includes migraine medications, corticosteroids, antibiotics, anti-inflammatory drugs.

Anisocoria in children

Childhood and adult anisocoria cannot be called a disease. The visual difference in pupil size also does not apply to pathology. Another thing is that the pupils react differently or do not react to light at all. This condition in children is not considered in the category of an independent disease.

In infants, a pathological symptom signals the incorrect formation of the central nervous system and brain. Underdeveloped cerebral hemispheres and cranial nerves determine different symptoms. A narrowed or dilated pupil that does not respond to light is subsequently accompanied by general dementia or a lag in the development of the child.

Violation of the muscles of the iris is the cause of acquired anisocoria in children, which occurs when:

• inflammatory diseases with a violation of the exchange of ions between the fibers, which violates the contractility;
• injuries that determine direct damage to myofibrils;
• unilateral compression of the brain after trauma or hematoma formed in newborns;
• diseases of the brain regions in the areas where the visual pathways are located disrupt the connections between the muscles of the eyeball and motor centers;
• inflammation of the meninges with the development of edema mechanically compresses the nerve bundles that innervate the eye.

Anticholinergics used to correct pupillary width in adults are usually not prescribed to children. Hereditary anisocoria is not dangerous. But if the expansion or narrowing of the pupil in a child is accompanied by blurred vision, dizziness, darkening in the eyes or vomiting, then a medical examination cannot be postponed.

Forecast

If the treatment of the underlying disease is effective, anisocoria completely disappears. With congenital pathologies of the eyes, which are the cause of different pupil diameters, they are most often eliminated due to reconstructive operations. If the surgical intervention is impossible, then the patient is prescribed drops that affect the work of the pupils for continuous use.

Conclusion

Pupils of different sizes are just a symptom that can indicate many diseases. Treatment is aimed specifically at getting rid of the underlying disease. Do not self-medicate, it is better to immediately contact a specialist for medical help. After the diagnosis, you will be offered treatment tactics and further recommendations.