Is anisocoria treatable? Anisocoria

When anisocoria is detected in a child, a scheme of simple sequential actions is used as shown in the attached algorithm. It is currently believed that anisocoria is a consequence of one of the following four pathologies:
1. Pathology of the sympathetic innervation of the dilator pupil.
2. Pathology of parasympathetic innervation of the sphincter of the pupil.
3. Pathology of the structure of the iris (congenital or acquired).
4. Benign or physiological anisocoria.

A) Horner syndrome. In most cases, you should start your diagnostic search with Horner syndrome. In this case, the maximum difference in pupil size will appear in the dark; ptosis of the upper eyelid can reach 1-2 mm; the lower eyelid may also be affected. The presence of heterochromia is possible, and if it is detected, then the cause of its appearance should be considered a congenital pathology. The possible presence of concomitant neuroblastoma or ganglioneuroma should be taken into account.

b) Oculomotor nerve palsy. Anisocoria caused by oculomotor nerve palsy is quite rare, but in reality will always be associated with oculomotor disturbances of varying severity. With congenital oculomotor nerve palsy and other congenital innervation disorders, the pupil is significantly dilated. Except in cases of chickenpox, the development of Adie syndrome (myotonic pupil syndrome) is extremely unusual in the first 10 years of life.

V) Structural anomalies. Structural abnormalities of the iris, with the exception of residual pupillary membranes, can cause pupils to develop larger or smaller than normal. Congenital idiopathic microcoria usually affects the eye on one side, often it is eccentric with a pupil measuring no more than 2 mm. The cause of this pathology is unknown. Congenital pupil-iris-lens membranes usually affect the eye on one side and cause pupil deformation, adherence of the iris to the lens with a rigid pupil, and progressive pupillary fusion.

It is believed that the cause of this process is a violation of the development of the iris and anterior chamber of the eye. It is also possible to develop acute closed-angle.

G) Physiological anisocoria. Physiological anisocoria is a common phenomenon observed in at least 20% of healthy children. Usually the asymmetry does not reach 1 mm, but sometimes it can differ from this value. Pupillary asymmetry occurs both in the dark and in bright light.

d) Use of pharmacological drugs. Of course, you can use pharmacological drugs to diagnose anisocoria, but in most cases, routine tests are sufficient for this, such as measuring the size of the pupil in different lighting, examining the iris and anterior chamber of the eye, and it is also worth paying attention to combined neurological symptoms.

To detect damage to the sympathetic innervation, some clinics prefer to use 0.5% topical apraclodinine instead of 4%, 5% or 10% cocaine hydrochloride. We do not use apraclodinine in children because of its long-lasting and acute hypnotic effects.

e) Slit lamp examination. To identify developing pathological changes in the pupil, as well as its non-standard reactions, it is convenient to conduct a study using a slit lamp. The eccentric location of the pupil suggests the presence of an underlying cause for its structural changes. Healthy children may have hippus (physiological lack of relaxation of the entire pupil).

and) Reactions to light and nearby objects. Particular attention should be paid to the reaction of the pupil to bright light and close objects. Bright light is an extremely important detail when examining the pupils. In Argyll Robertson pupil, aqueduct of Sylvius syndrome, and Adie syndrome, bright-near dissociation is observed (the pupil responds better to a close object than to a bright light). Whenever possible, pupil dimensions in the dark and in the light are recorded and photographed.

It is possible to use photographs from family archives. The most common cause of pupillary asymmetry at any age is physiological anisocoria.

h) Refraction. It is convenient to perform retinoscopy when studying the reaction to a nearby object. Extremely important information about pupillary accommodation (accommodation caused by a nearby object) is provided by dynamic changes during retinoscopy. Despite the fact that poor accommodation is characteristic of cerebral palsy and Down syndrome, in these conditions the response to light and a nearby object remains unaffected.

And) When to Diagnose Horner Syndrome. Most doctors believe that it is extremely necessary to examine a child with different pupils, because this pathology may be a sign of a serious systemic or neurological disease, which is especially important when diagnosing Horner syndrome in pediatrics, where there is always the possibility of detecting concomitant neuroblastoma. The only question is how deeply the research needs to be done.

Expert opinions differ: some believe that in-depth studies are needed, others are confident that routine tests are sufficient. We believe that additional research is necessary if a hereditary cause is suspected, or if a child suffers from this disease, or if there are symptoms of brain involvement, such as anhidrosis.

Most people have seen anisocoria at least once, either in person or in pictures. This condition is characterized by an unnatural change in one pupil or both at once. Anisocoria is not an independent pathology; it is often a symptom of a disease.

Pupil characteristics

The specific anatomical structure of the pupil cannot be described. The pupil is simply a hole in the iris through which almost 100% of light rays are absorbed. These rays do not go back through the iris and are absorbed by the inner membranes, which causes the blackness of the pupil in all healthy people.

The pupil acts as the eye's diaphragm, regulating the amount of light entering the retina. In bright conditions, the circular muscles contract, while the radial muscles, on the contrary, relax, which leads to a narrowing of the pupil and a decrease in the amount of light entering the retina. This mechanism protects the retina from damage. When there is insufficient light, the radical muscles contract and the annular muscles relax, which dilates the pupil.

The reduction of the pupil is carried out by the parasympathetic nervous system, and the increase is carried out by the sympathetic nervous system. In bright light, the sphincter muscle works, and in dark light, the dilator muscle is activated.

Such changes can occur several times per minute. This is how photons are distributed, which irritate the retina. Anisocoria is a consequence of a mismatch in the functioning of the muscles of the iris. The patient has different pupil sizes and, accordingly, different degrees of response to lighting.

The oculomotor nerve muscles of the iris allow simultaneous changes in the pupils of the eyes. Surprisingly, if you shine light into one eye, the pupils will narrow in both at once, and simultaneously. This phenomenon is possible only with proper functioning of the iris muscles. If narrowing does not occur in the second eye, we can talk about pathology. A narrowing of the pupil from normal is called miosis, and dilation, accordingly, is called mydriasis.

It is noteworthy that physiological anisocoria is observed in many representatives of the fauna. For example, in reptiles and amphibians, due to the lack of (perception of a picture with both eyes), such synchrony of ocular reactions is not always observed.

The pupils are capable of reacting not only to light rays. Many strong emotions (fear, pain and excitement) can affect the size of the pupil. Also, some medications change the functioning of the iris.

Classification of pathology and its causes

There are several main causes of anisocoria, which involve dozens of different diseases and conditions. In 20% of cases, anisocoria in infants is a consequence of a genetic defect. The child most often does not have any other symptoms, and the pathology of the pupil does not exceed 0.5-1 mm. In such cases, anisocoria may disappear by 5-6 years.

Types of anisocoria

1. Congenital. This type of pathology is often the result of a defect in the eye or its individual elements. The reason affects the muscular apparatus of the iris and causes asynchrony in the reaction of the pupils to light. It happens that congenital anisocoria is a symptom of underdevelopment of the nervous system of one eye or both, but in almost all cases the pathology is complemented by strabismus.
2. Acquired. There are many reasons that can cause anisocoria throughout life.

One of the most common causes of pupillary mismatch is injury. There are several types of injuries that can cause anisocoria. First of all, these are eye injuries. Often the synchrony of pupil reactions is disrupted due to damage to the iris or ligamentous apparatus of the eye. With an eye contusion, when there are no visible injuries, paralysis of the muscular structure of the iris may develop, and the pressure inside the eye will increase.

When a head injury occurs, there is always a risk of injury to the skull or brain. Anisocoria may be the result of impaired functionality of the nervous system of the eyes or visual centers in the cerebral cortex. When the visual centers are damaged, strabismus often develops. Disturbance in the functioning of the optic nerves often leads only to one-sided dilation of the pupil. Distinctive feature: the pupil dilates in the eye on the side of the injury.

Eye diseases also often manifest themselves through anisocoria. Such ophthalmological disorders can be inflammatory or non-inflammatory in nature. Iritis and iridocyclitis (isolated inflammation of the iris) can cause spasms of the iris muscles. As a result, the eye stops responding to changes in light, which is expressed by mismatch of the pupils. Glaucoma often provokes a narrowing of the pupil in the affected eye (permanent): this makes the outflow of intraocular fluid faster and easier.

The growth of neoplasms and tumors in the head leads to a weakening of the connection between the eyeballs and visual centers. As a result, the functionality of the iris is impaired. Such pathologies include malignant brain tumors, neurosyphilis, and hematomas in the brain after a hemorrhagic stroke.

Anisocoria can appear when exposed to certain inorganic substances: belladonna, atropine, tropicamide. When these compounds affect the nerves and muscles of the eye, pupil misalignment may occur.

Diseases of the brain and visual nerve pathways are also at risk. Among the main diseases of the central nervous system that can cause anisocoria are neurosyphilis and tick-borne encephalitis, meningitis and meningoencephalitis.

Types of anisocoria

1. Caused by eye pathologies. The condition occurs due to disturbances in the elements of the eye.
2. Caused by other pathologies.

According to the degree of involvement, unilateral and bilateral anisocoria are distinguished. In 99% of cases, a unilateral eye pathology is diagnosed, that is, one normal eye reacts to changes in light, and the pupil of the second either does not react or functions late.

Bilateral anisocoria is a fairly rare occurrence. The condition is characterized by an uncoordinated and inadequate response of the iris to changes in the visual regime. The degree of pathology may be different for each eye.

Diagnosis of the causes of pupillary defect

The first stage in diagnosing the causes of anisocoria is collecting an anamnesis. The doctor must identify all concomitant pathologies, study their causes, development and duration. Photographs of the patient help in diagnosing anisocoria. From them you can find out whether the pathology existed before and with what dynamics it developed.

During an eye examination, the doctor determines the size of the pupils in light and in the dark, reaction speed, and consistency under different lighting conditions. These simple characteristics help to at least approximately determine the cause of anisocoria and the localization of the disorder that provokes pupil mismatch.

Anisocoria, which is more pronounced in bright light, is indicated by pathology when the pupil dilates to a large size and has difficulty constricting. With anisocoria, which is more pronounced in a dark environment, the pupil becomes unnaturally small and dilates with difficulty.

Methods for diagnosing anisocoria

1. Cocaine test. In the process, a 5% solution of cocaine is used (if the patient is a child, a 2.5% solution is used). Sometimes the cocaine solution is replaced with apraclonidine 0.5-1%. The test allows you to differentiate physiological anisocoria from Horner's syndrome. The procedure is simple: drops are instilled into the eyes, the size of the pupils is assessed before the procedure and after 60 minutes. If there are no pathologies, the pupils gradually dilate. In the presence of Horner's syndrome, the pupils on the affected side dilate to 1.5 mm.
2. Phenylephrine and tropicamide tests. A solution of 1% tropicamide or phenylephrine reveals a defect in the third neuron of the sympathetic system, although a defect in the first and second cannot be excluded. The procedure is as follows: drops are instilled into the eye, analyzing the size of the pupils before and after the procedure (after 45 minutes). An expansion of less than 0.5 mm will indicate pathology. With an increase in anisocoria by 1.2 mm, we can talk about damage with a probability of 90%.
3. Pilocarpine test. For the procedure, 0.125-0.0625% is used. Pupils with a defect are sensitive to the product, while healthy eyes do not react to it. Pupil dilation should be assessed half an hour after instillation.

Anisocoria may be associated with the following symptoms

1. Pain. May indicate expansion or rupture of an intracranial aneurysm, which is dangerous due to compression paralysis of the third pair of oculomotor nerves. Pain also appears during dissection of the carotid artery aneurysm. Another cause of pain may be microvascular oculomotor neuropathy.
2. Double vision.
3. and diplopia. May indicate damage to the third pair of oculomotor nerves (cranial).
4. Proptosis (protrusion of the eyeball forward). Often accompanied by space-occupying lesions of the orbit.

If vascular abnormalities are suspected, contrast angiography and Doppler ultrasound are prescribed. Diagnosis of ocular dysfunction often includes CT, MRI and MSCT with vascular contrast. Even if there are no other symptoms, these tests can detect aneurysm and brain tumor - the most common causes of anisocoria. Neuroimaging studies allow us to determine the exact treatment plan and the need for neurosurgery.

Treatment of anisocoria

For anisocoria that is not caused by pathology of the iris, treatment should be aimed at eliminating the underlying disease. Pupillary mismatch will disappear on its own after successful therapy.

If the cause lies in an inflammatory disease of the brain (meningitis, meningoencephalitis), broad-spectrum antimicrobial agents, detoxification therapy and measures to correct the water-salt balance are needed.

In case of head injuries, you need to act quickly: lack of synchrony in the pupils is a bad symptom. Surgery to the skull is often required to eliminate the dangerous consequences of the injury.

If pupil mismatch is caused by injury or disease of the eye, the therapy is more clear-cut. It is necessary to eliminate the pathology and correct the muscle activity of the iris. The doctor prescribes medications that directly affect the processes of dilation and constriction of the pupils. For iritis and iridocyclitis, anticholinergic drugs are needed that relax the muscles of the iris. Long-term use of such drugs can lead to permanent dilation of the pupils. Ophthalmologists also prescribe medications to eliminate inflammation.

With congenital anisocoria, the question of treatment will depend on the degree of the disorder. Most often, several operations are required to correct the eye defect. It is rare, but it happens that surgery is impossible (0.01% of all cases of congenital anisocoria). In this case, patients are prescribed eye drops for life.

Pupils of different sizes are not the most common sight. Therefore, parents of children who have such asymmetry are quite rightly alarmed. We will tell you in this article whether anisocoria is dangerous and why it occurs.

What is it?

Different pupil sizes are called anisocoria in medical terms. This is by no means an independent disease, but only a symptom of some disorder in the body.

Therefore, it is not the symptom itself that should be identified and treated, but the true cause that led to the fact that the pupils have acquired different diameters.

The pupil is created by nature and evolution so that the number of rays hitting the retina is regulated. So, when bright light enters the eyes, the pupils narrow, limiting the number of rays, protecting the retina. But in low light, the pupils dilate, which allows more rays to hit the retina and form an image in poor visibility conditions.

With anisocoria for a number of reasons one pupil stops working normally, while the second one functions in accordance with the norms. In which direction the “sick” pupil will change - will it increase or decrease, depends on the causes and nature of the lesion.

Causes

The reasons for asymmetric pupil diameter in a child can be different. This includes physiology, which is quite natural under certain circumstances, and pathology, and a genetic feature that a baby can inherit from one of the relatives.

Physiological

Such completely natural causes of imbalance are usually observed in every fifth child. At the same time, in many children the problem goes away on its own closer to 6-7 years. The dilation of the pupil can be affected by the use of certain medications, for example, psychostimulants, severe stress, strong emotions, fear experienced by the child, as well as insufficient or unstable lighting where the child spends most of his time.

In most cases it is observed symmetrical reduction or enlargement of the pupils relative to the norm, but this does not always happen. And then they talk about physiological anisocoria. It is quite simple to distinguish it from pathology - just shine a flashlight into the child’s eyes. If both pupils react to changes in light, then there is most likely no pathology. In the absence of one pupil, changes in the intensity of artificial lighting indicate pathological anisocoria.

The physiological difference between the pupil diameters is no more than 1 mm.

Pathologies

For pathological reasons, one pupil is not just visually larger than the other, the functionality of the pupils changes. The healthy one continues to respond adequately to light tests, to changes in lighting, to the release of hormones (including fear, stress), while the second one is fixed in an abnormally expanded or contracted position.

Congenital anisocoria in infants may be a consequence of a disorder in the structure of the iris.

Less commonly, the cause lies in underdevelopment of the brain and dysfunction of the nerves that move the extraocular muscles and the sphincter of the pupil.

An acquired problem in children may be a consequence of a birth trauma, especially if the cervical vertebrae were injured. Such anisocoria is diagnosed already in a newborn, as is genetic asymmetry of the pupils.

Different sized pupils may be a sign of traumatic brain injury. If a symptom first appears precisely after a fall or a blow to the head, then it is considered one of the main ones in the diagnosis of traumatic changes in the brain. Thus, by the nature of anisocoria, one can determine which part of the brain is subjected to the strongest pressure during a cerebral hematoma or brain contusion.

Other reasons

Other causes:

Taking narcotic drugs. At the same time, parents will be able to notice other oddities in the behavior of their child (usually adolescence).

Tumor. Some tumors, including malignant ones, if they are located inside the skull, may well put pressure on the visual centers during growth, as well as interfere with the normal functioning of the nerve pathways through which the brain sends a signal to the visual organs to narrow or dilate the pupil depending on the surrounding environment. conditions.

Infectious diseases. Anisocoria can become one of the symptoms of an infectious disease, in which the inflammatory process begins in the membranes or tissues of the brain - with meningitis or encephalitis.

Eye injuries. Blunt trauma to the pupillary sphincter usually leads to anisocoria.

Diseases of the nervous system. Asymmetry in pupil diameters can be caused by pathology of the autonomic nervous system, in particular, the cranial nerves, the third pair of which is responsible for the ability of the pupil to contract.

Diseases that cause anisocoria:

Horner's syndrome - in addition to the reduction of one pupil, there is a retraction of the eyeball and ptosis of the upper eyelid (drooping eyelid);

glaucoma - in addition to constriction of the pupil, severe headaches caused by increased;

the Argyll-Robinson phenomenon is a syphilitic lesion of the nervous system, in which photosensitivity decreases;

Parinaud's syndrome - in addition to pupil asymmetry, multiple neurological symptoms associated with damage to the midbrain are observed.

Symptoms

The symptom does not require special observation from adults. If one pupil exceeds the norm by more than 1 mm, this becomes noticeable even to a layman, and even more so will not hide from the attentive gaze of a caring mother.

Anisocoria should always be examined by two specialists - an ophthalmologist and a neurologist.

There is no point in waiting until the eyes take on a normal appearance and the difference disappears on its own (as some parents believe, who are sure that children under 4 months of age have different pupils in general). Timely The examination will eliminate the unpleasant symptom and its causes completely.

You should immediately go to the doctor if the child not only has pupils of different sizes, but also has a severe headache, attacks of nausea, if the asymmetry was preceded by a fall, head hits, or other injuries, if the child begins to be afraid of bright light, his eyes are watery or he complains that he has begun to see worse and the image is double.

Diagnostics

The doctor’s task is to find an unhealthy pupil, determine which of the two pupils is suffering and which one is working normally. If symptoms worsen in bright artificial light, doctors tend to believe that the cause lies in damage to the oculomotor nerve. In this case, the diseased pupil is usually dilated.

If light testing shows that a child feels worse when there is a lack of lighting or in the dark, then the reason most likely lies in damage to the brain stem structures. The pathologically altered pupil is narrowed and does not expand in the dark.

After inspection The child is prescribed an MRI. This method allows you to confirm or refute preliminary conclusions, as well as clarify the “problem” location.

Treatment

The famous pediatrician, the favorite of many mothers around the world, Evgeniy Komarovsky, warns parents against self-medication. Pupils of different sizes are a task for qualified doctors; no decoctions, lotions or miracle drops at home will help with anisocoria. If physiological anisocoria is diagnosed, there is no need to worry; it is enough to visit an ophthalmologist at the age of 3-4 to check your vision. In most cases, asymmetry of pupil diameters does not have any effect on the child's visual acuity.

The method of treating anisocoria depends on the true cause of the phenomenon. In case of ophthalmic injury, the eye doctor prescribes anti-inflammatory drops and antibiotics to eliminate inflammatory post-traumatic syndrome. If the cause is a tumor in the brain, then drug treatment or surgical removal of the tumor is prescribed.

If the true cause lies in a neurological disorder, the treatment prescribed by a neurologist comes first - a complex of massage, medications, and physiotherapy.

The child is recommended to take nootropic drugs, improving cerebral circulation, as after a traumatic brain injury.

Doctors' forecasts

Prognosis for anisocoria depends only on how quickly the real cause of the disease is identified, and on how quickly and effectively the child receives the necessary treatment.

Congenital pathology successfully treated surgically. If the operation is not possible for a number of reasons, the child is prescribed drops in the eyes, which, if taken systematically, will maintain normal vision. For acquired anisocoria, the prognosis is more favorable, while some congenital cases remain with the child for life and cannot be corrected.

To learn how the diagnosis is determined based on the pupil, see the following video.

The main function of vision is to transmit visual information about the world around us in the form of electrical signals to the brain. The eyes are connected to the human central nervous system by optical nerves, thanks to which a person reacts quickly to the picture he sees.

And any deviation in the work or structure of the organ of vision can lead to dire consequences. One of them is anisocoria - a condition when there is a noticeable difference in the size of the pupil. In this case, one eye works normally, in the other the pupil does not react to light, remaining at a fixed size.

Pupillary reflex, its importance for full vision

The visual image perceived by the eye passes through the cornea, pupil, lens, and vitreous body before reaching the retina. Depending on the brightness of the light flux penetrating the eyeball, the size of the pupil in the iris changes.

It is the responsibility of the muscle fibers to narrow or widen this dark hole in the iris. The sphincter muscle, to narrow it, surrounds the opening with circular fibers, and the dilator is formed by radial muscle fibers extending out like the spokes of a wheel. Both muscles move under the influence of parasympathetic and sympathetic nerves.

Bright light causes the iris to shrink, and the light flux entering the eyeball becomes less. When the lighting level decreases, the activity of nerve fibers is inhibited, the sphincter relaxes, and the pupil becomes dilated.

With a high degree of physical activity or a surge of emotions, the dilator fibers dilate the pupil. Nerves and muscles set it in motion and help form a clear image when a person examines nearby objects or tries to see something in the distance.

Forms of violation, their features

The origin of anisocoria can be different, therefore, both congenital and acquired forms of the disease are distinguished.

The abnormal structure of the iris is associated with abnormalities in the functioning of the muscles and nerves of the eye. If the difference between the pupils is small, no more than one millimeter, then this is considered normal, especially since it does not affect visual acuity. Statistics say that physiological deviation occurs in every fifth inhabitant of the planet.

If nerve or muscle conduction is impaired, when the pupil does not respond to the brightness of the light flux, you should consult a doctor. After all, this can be a manifestation of various types of diseases, both ophthalmological and neurological, traumatic or infectious.

Provoking reasons

Pathological changes in the iris lead to a lack of pupillary response to light, accommodation, or the ability to clearly see objects at any distance. There are many reasons and diseases in which the pupils become different sizes and anisocoria develops:

Anisocoria is not an independent pathology, it is only a symptom of abnormalities in the functioning of the brain and the structure of neural connections.

Anisocoria in children and adults: features

A congenital disorder in the functioning of the pupil can be noticed in infants, but this may be a physiological phenomenon that takes place over several years.

Dysfunction of the pupil of one eye can develop as a result of birth trauma or genetic predisposition. If the child’s parents discover that his pupils are unevenly spaced or of different sizes, then you should consult a doctor and check for concomitant diseases, such as drooping upper eyelid, strabismus, or restriction in the movement of the eyeball.

In children older than one year, the symptom of different pupils may appear as a result of a brain tumor.

In such cases, there is a decrease in the diameter of the pupil in a dark room, although the child’s image clarity does not suffer, he sees well what is far or close. The abnormality of the pupil is manifested by visual impairment, the appearance of fear of light. This should alert the child’s parents, and a visit to the doctor is mandatory.

Causes and diseases that provoke pupils of different sizes can manifest themselves both in young people and in adults after fifty years.

Prescription of medications occurs after a complete examination and identification of the cause of the deviation. The main efforts are directed at treating the underlying disease, a sign of which is a narrowing or dilatation of the pupil in one eye.

Among the prescribed drugs: corticosteroids to relieve inflammation, antibacterial agents that actively affect pathogenic microorganisms.

Anisocoria caused by eye trauma is treated with medications that relax the muscles of the iris. These include drops Irifrin, Atropine. The ophthalmic drug Cyclomed and Midriacil, which belongs to the group of anticholinergics, is used to dilate the pupil.

Among folk remedies, inflammation of the membranes of the eye is relieved by liquid aloe extract used for lotions. An infusion of a mixture of carrots and dry stinging nettle, taken in the amount of two tablespoons, is prepared from half a liter of boiling water. After two hours, drink the drink; such daily treatment will strengthen your eyesight.

Correctly selected treatment will help you get rid of the disease. In some cases, surgical intervention may be necessary.

Consequences of violation

Disturbances in the functioning of the eye muscles and nerve fibers can lead to the patient developing inflammatory processes in the iris, iritis. They usually occur in people under forty years of age, less often in children and the elderly.

During the course of the pathological process, the pattern of the membrane changes, becoming blurred, and visual acuity decreases. The patient feels constant pain in the head, radiating to the temporal region. The chronic form of inflammation can result in eye atrophy.

With diplopia, or the image is blurry. This greatly tires a person, he begins to see objects poorly, feels discomfort, and dizziness. A neurologist and ophthalmologist will help identify the cause and prescribe treatment.

Different pupil sizes often lead to strabismus, which develops in children due to uncoordinated activity of the eye muscles. The organ of vision that squints does not participate in the visual process and becomes lazy. It is possible to cure this form of pathology in children with the help of medications and wearing special glasses.

Avoiding the unpleasant consequences of acquired anisocoria is the task of specialists, to whom a patient with damage to the nerve fibers of the eye should contact in a timely manner.

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The pupils are normally symmetrical, but 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. or narrowed and we will consider further.

Symptom Definition

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:

1. Limited movement of the eye or both eyes.
2. Ptosis ().
3. High temperature, febrile state.
4. Headaches, nausea, vomiting.
5. 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 that many people normally have different pupil 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 with 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 differences in pupil size can be a manifestation of Horner's syndrome, in which case ptosis is associated with 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.
• Medicines.
• 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

If this may indicate the following diseases:

1. Iritis is an inflammatory disease of the iris of the eye.
2. Infectious eye diseases.
3. Eye injuries.
4. Horner's syndrome is increased anisocoria when being in the dark or when the light source is removed.
5. Eydie's syndrome is a slow reaction of the pupil during eye movements, leading to and.
6. Migraine attacks that cause one-sided mydriasis.
7. 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 wider than normal, 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:

1. Timely visit to a neurologist or ophthalmologist when the first symptoms of anisocoria appear.
2. Cholesterol level control and correction.
3. Blood pressure control.
4. 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.