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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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one of my pupils is bigger than the other should i be conc

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one of my pupils is bigger than the other should i be concerned.

Doctor DanB : Hello and thanks for your question. Are you available to chat?
Customer:

yes

Doctor DanB : It may be difficult to tell, but approximately how many millimeters different are the two pupils? Do you have any headaches? How about a drooping of one eyelid that is not normal for you? Any double vision?
Customer:

headache yes. do not know how i would measure them. no drooping sometimes double vision

Doctor DanB : Is this headache, new for you or is this uncommon? Is it severe? Is the double vision a new thing for you? If not, how long has it been happening? Can you give me an approximate size difference between the two peoples? A very large difference?
Doctor DanB : Are you still here?
Doctor DanB : Since you don't seem to be at your computer I'll tell you my opinion based on the info I have.
Doctor DanB : When a there is a difference in pupil sizes, this is call anisocoria. Depending on how the pupils react and whether there are other associated signs, this can be caused by several significant medical problems, or it could be just the way you're "wired" so to speak, even if did just come on recently--this is called a physiologic anisocoria, or a difference in pupil sizes that is always less than 2mm, isn't associated with any other signs or symptoms and isn't caused by any significant medical pathology. For those people who have a physiologic anisocoria, the amount of size disparity can vary from day to day and the "abnormal" pupil can even change sides. But a physiologic anisocoria is also usually the same size disparity in both well-lit and dim environments. This is a diagnosis of exclusion, meaning other significant medical problems have to first be ruled out before arriving at this benign diagnosis.
Doctor DanB : A Horner's syndrome is an interruption of the normal, sympathetic nervous system pathways that lead from the spinal cord, up the chest, into and up the neck, and then through the head to the eye. It is usually associated with a droopy eyelid, and can be associated with a cough or asymmetric sweating on the face or sides of the body. In your instance, the eye that likely has the abnormality is not the eye with the larger pupil in the dark, but the smaller one (as the normal physiological pupillary response in a dark environment is dilation and not pupillary constriction. Given that you have a headache which can be an etiological clue of a Horner's syndrome, it may be more possible that this is a Horner's syndrome than a physiologic anisocoria. Nevertheless, because a Horner's syndrome can have serious medical implications it is important for you to see an ophthalmologist or neurologist as soon as you can. If you develop double vision, or decreased vision you should go to an ER right away.
Doctor DanB : Does this make sense? Does this information help address your concerns? Do you have any other questions about this? It appears as though you are not in the chat room currently. I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need. If you would like to ask further questions or clarification regarding anything I've said, please let me know and I will be happy to address your concerns when I return to see if you've responded. If your concerns have been resolved... Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied. My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!
Customer:

the headaches are new, my right arm feels like it is asleep most of the time. my neck is very sore like i pulled something. pretty sure i didnt. thank you so much for your time and consideration. by the way been going on for a week.

Doctor DanB : Yes. I think you really do need to see an ophthalmologist finger this thing checked out. While its most likely the physiologic anisocoria I was referring to earlier, you don't need to take a chance with your health. I hope this has been helpful. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied.
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