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Ask Dr. Rick Your Own Question

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7854
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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My 22 year old son woke up this morning with one pupil dia

Resolved Question:

My 22 year old son woke up this morning with one pupil dialated.
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Rick replied 3 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

Are you available to chat?

Dr. Rick :

How is his vision? Does he have any other symptoms anywhere in his body? Does he have any medical problems or take any medicines? Any drugs I should know about? Any trauma? Does his eye hurt?

JACUSTOMER-fb3cz8lt- :

He will be here in a minute. His right pupil is significantly larger than his left. When he looked into a light both pupils shrank but the right pupil was slower to respond.

JACUSTOMER-fb3cz8lt- :

are you there?

Dr. Rick :

yes

JACUSTOMER-fb3cz8lt- :

did you get my information?

Dr. Rick :

yes. Did you see the slew of questions I posted?

Dr. Rick :

What part of the US are you in?

Dr. Rick :

Also, one more question. Does one of his upper eyelids seem "droopy'?

JACUSTOMER-fb3cz8lt- :

Andy smokes, he is on Adderall 20 mg, he smoke marajuana on a regular basis. He is just getting over the flu (raw throat, chills, temperature, significant fatigue). no headache,

Dr. Rick :

well, tobacco, adderall and marajuana shouldn't cause any pupil problems...although he should give up tobacco on general principles

JACUSTOMER-fb3cz8lt- :

No trauma, no eye pain, he does seem acceptionally agitated and angry.

JACUSTOMER-fb3cz8lt- :

agreed about the smoking...

Dr. Rick :

agitated and angry to the point that you might worry about brain problems/damage?

Dr. Rick :

How about the upper eyelid position. Have him look at you, hold his eyes normally open and compare where the bottom of the upper lid crosses the arc of his clear cornea/colored iris...

JACUSTOMER-fb3cz8lt- :

He has bi-polar disorder. But he does seem to be even more emotional than normal

Dr. Rick :

what does he take for his bipolar? Lithium?

JACUSTOMER-fb3cz8lt- :

nothing he won't take anything but pot

Dr. Rick :

bet that does't work too well......but we digress. Did you get a chance to look at his eyelids

JACUSTOMER-fb3cz8lt- :

the only difference with the right eye lid is that it is sagging a little versus the left upper eye lid

Dr. Rick :

Ok. Well, there are many causes of different pupil sizes (anisocoria). My questions to have made one of the serious ones very unlikey

JACUSTOMER-fb3cz8lt- :

good, what should we do?

Dr. Rick :

The most common cause of this in an otherwise healthy 22 year old is called physiologic anisocoria. This is nothing to worry about is seen all the time. It can also be seen in migraine headaches, which he doesn't have, third nerve palsey, mechanical damage to the pupil, intraocular inflammation/trauma etc.

Dr. Rick :

The botXXXXX XXXXXne here it, that in your son

Dr. Rick :

's case I do not believe there is anything to worry about.

Dr. Rick :

Since he has not had any recent head or neck trauma, and would be unlikely to have any of the nasty intracranial disease processes, lung cancer etc I think it would be safe to just watch things at this point

JACUSTOMER-fb3cz8lt- :

This might not be related but I am on medical leave with bells palsey. My doctor believes it is due to herpes zoster attaching my 7th cranial nerve. Could Andy have a similar problem?

Dr. Rick :

Unlikely as Bells palsey affects the nerve that closes the eyelid and not the nerve trunks that make the pupil dilate and constrict. Also Bells Palsy is not contageous.

Dr. Rick :

oops.....sorry for the typo's :) I really can spell....

Dr. Rick :

The way to be 100% sure about your son, of course, is for him to be evaluated by an ophthalmologist who can closely examine his dynamic pupil function in a controlled setting with a dark and then a very light room, as well as a slit lamp and other special equipment.

JACUSTOMER-fb3cz8lt- :

ok thanks, XXXXX XXXXX take him in tomorrow. Is there any symptom we should watch for that would make this an emergency to take him in today?

Dr. Rick :

Nothing specific as I really think everything will be OK, but if he starts to loose body function, get really confused, be unable to open his eye you should take him to the ER.....but I really don't think that will happen -- which is a good thing :)

Dr. Rick :

does that make sense to you?

Dr. Rick :

still there?

Dr. Rick :

And, now, the obligatory word from our sponsors: :o)


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Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7854
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 3 years ago.
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Expert:  Dr. Rick replied 3 years ago.
.
Expert:  Dr. Rick replied 3 years ago.
One of the other ophthalmologists on this site (eyeMD.00) had some very important insight concerning your son's pupil abnormalities that I didn't think of when we talked.

He pointed out that: "Adderall being an amphetamine can cause mydriasis (larger pupil size). Marijuana can cause miosis (smaller pupil size). The combination of those two on board is likely causing the pupil abnormality."

The words inside () were added by me....

This is an excellent point and, once again, means there is very little need to worry about your son at this time.

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