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Dr. Stevens
Dr. Stevens, Ophthalmologist
Category: Eye
Satisfied Customers: 1404
Experience:  Board Certified Ophthalmologist
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My 8 mo old has anisocoria R L by 2-3mm at a given time. More

Customer Question

My 8 mo old has anisocoria R>L by 2-3mm at a given time. More noticeable in artificial light. Both constrict equally in direct sunlight. no noticeable depigmentation of the iris in the left, maybe some upper lid drooping on the left. Don't know if the left won't dilate or if the right is not constricting well. The right is the one that looks out of place. Noticed first at about 2-4 weeks of age. C/S with vacuum and a persistent caput for about a month I think. Vision in both eyes seems fine. Cannot tell discrepency in photos. not crawling yet, other 2 kids were walking by now-almost. pushes her head along the floor with butt in air to move. Seems to turn whole body to see beside her vs. just her head. Likely problem? Horners, CN III palsy???
Submitted: 8 years ago.
Category: Eye
Expert:  Dr. Stevens replied 8 years ago.

Hello there

you seem to have a good amount of knowledge of this....I understand the right eye is the one with the larger pupil ?? is that right? is she able to move her eyes all around and fully?

Customer: replied 8 years ago.
Yes, it is her right pupil that appears unusually bigger. She does seem to be a ble to move the eyes around fully. But, when you are seated to the side and slightly behind her, she tends to crane her neck as well as trying to look at you out of the corner of her eye. In photos, her pupils seem to be equal, but the light reflection is not in the exact same spot of the pupil, if that makes since.
Expert:  Dr. Stevens replied 8 years ago.

Hello there

she does not have a 3rd nerve palsy, that would make the larger pupil eye the involved eye and it would track poorly and have a severe droop. Now the left eye has a slight droop and has a smaller pupil....this would be consistent with Horners in the left side but the pupil abnormality should be more noticeable in the dark situations. So with this the abnormal pupil would be the left pupil. My experience is that most often there is some physiologic anisocoria and nothing is wrong. I think this warrants a visit to the ophthalmologist for their evaluation and management. I wish her well, Dr. Stevens

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Customer: replied 8 years ago.
I do feel that the discrepency is more noticeable in darker light. So even though the right pupil appears more unusual, it is probably the left pupil that is not able to dilate fully? We have an appt. in June. What diagnostic tests should I expect?
Expert:  Dr. Stevens replied 8 years ago.
If they think that this is a Horner's, they will probably due a CT or MRI.....first thing though would be in office testing to determine what type of Horner's (eyedrops used to check pupil response). I am glad she is referred for evaluation, I would try to move up the appt if possible, perhaps call weekly for cancellations, etc. Regards XXXXX XXXXX