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Anisocoria (Unequal Pupils)

 
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Anisocoria

  • Look For

  • Unequal pupils.
Ask about whether the patient has had unequal pupils in the past, or if they have an old ID photo to compare to.
  • Causes of Anisocoria

  • Physiological (20% of the population)
  • Migraine
  • Post-ictal
  • Horner’s syndrome (unilateral)
  • Drugs applied to one eye - pilocarpine, tropicamide, cocaine
  • Intraocular conditions - glaucoma, retinal detachment
  • Oculomotor (III) nerve lesion - nerve trauma, nerve compression, optic neuritis, Guillain barré
  • Adie's tonic pupil
  • CNS lesion - head trauma, intracranial tumour, subarachnoid haemorrhage, ischaemic stroke, multiple sclerosis
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