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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35437
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have uneven size pupils, the left side bigger and the

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I have uneven size pupils, the left side bigger and the right side always the smaller and this change has been getting worse with the size differents and how often, can you help me pinpoint what the cause is?


To a small extent a difference in pupil size is normal, and may vary from left to right over time. However, if there is a larger discrepancy in pupil size it may indicate or warn of a neurological issue.

The determination of the causative of discrepancy in the size of pupil will need following:

1) A physical examination by a neurologist and eye specialist.

2) Fundus examination

3) CT or MRI of the brain and eye balls

Anisocoria (uneven pupils) is condition where one pupil is larger than the other. the causes can be trivial to some which will need medical intervention. Following are the causes;

1) Physiologic anisocoria; there is no vision loss or double vision, so nothing is to be done. The size discrepancy is usually 1 mm.

2) Horner syndrome; due to sympathetic dysfunction of the nervous system. There is associated eye lid fall. Will need further thorough investigations.

3) Third cranial nerve paralysis; blood vessel aneurysm or tumor may cause it.

4) Damage to Iris of eye; should be conformed by eye specialist.

5) Drugs

6) Tonic pupil

So an examination is essential for pin pointing the cause.

Hope this helps.

Your follow up questions are welcome.


Dr. Arun Phophalia and 3 other Health Specialists are ready to help you
Customer: replied 9 years ago.
Reply to Dr. Arun Phophalia's Post: The thing is i have many other symptoms and some may or my not help but i was hoping to give it a try but didn't realize that I should have added the whole question in the first place. First, i'm not sure if this matters but i had a c-section and for me this was like the end of the world I've heard that trama can cause this but maybe this isn't the right kind. 2 or so month after surgery i noticed my pupils different by a small bit, not even my husband couldn't tell now he knows they are different about 6 months later .I'm sensitive to light have headaches and kind of a achy felling in my right eye maybe a bit in the left after sunlight unless this is the flu going around and a very snappy/moody and very tired in the last 2 weeks. After, a lot of light enters my eye's they seem to take longer to dialate. Down my right shoulder and arm tingles sometimes daily. I did have a strange twitching sensation on the end of my nose a few weeks ago but now it's very dull.About 2 months ago I got really upset and cried a lot and my right eye felt like it was going to blow up. I can see a pulse in my right lip, but I did have an infection from the dentures that I was fitted for cut into my gum under my right eye. I have sudden heartburn that even wake me up when I'm asleep and only happen when I lay down. The only Med's I take are Vitamins, Iron for Anemia and multi- vitamin.I was thinking maybe the heartburn was because of the iron it ends up to be 60mg. And dark runny stool almost every morning and maybe twice a month normal. Could this have anything to do with it? Could any of it? I was really hoping that I could narrow my visits to the doctors since I've done this and I'm still struggling and scared.

Hello Reena,

Your gastrointestinal problems may not be related to your unequal pupil. This may be, as you mentioned because of either iron or multivitamins. The C-section may be just a co-incidence, as medically they are difficult to correlate each other.

Since unequal pupil is quite a complicated phenomenon, it is difficult to sort out in online forum. At best it can guide you. The pupil size depends upon the effects of the autonomic nervous system and the iris muscle. So by a physician examination it is necessary to atleast tell what specialist to be consulted. An iris problem will need an eye specialist while autonomic nervous system problem would be dealt by a neurologist.

Light sensitivity, shoulder and arm tingling, tiredness, etc points towards neurological ailment and may be neurologist would be the best to start with. But as I mentioned, anisocoria can be just benign (nothing) or something serious, so you need to do something as soon as possible. With a small interaction with you, I feel your symptoms may be compounded by stress or anxiety also, so that part also needs to be taken care of.

Hope this helps you. Please feel free to ask your further queries.

Dr. Arun