Question
hi,
last summer i noticed thst my right pupil always looked smaller thsn the left, they react at the same time, i finally saw a optician in december and was refered to see an optomologist at my local hosp i had this app on sat he had a good look in my eyes and said it was just one of those things,
my question is could he have missed something, i supppose i have done my self no favours by looking on the internet at what this could mean, my eye lid does not droop nor do i have any double vision,
Answer
A smaller pupil in one eye (anisocoria) can be congenital or acquired. If you don't have lid droop (ptosis) or miosis (small , constricted pupil) , and anhydrosis (lack of sweating), the chances are you no NOT have Horner's Syndrome. One additional sign in enophthalmos which is where the eyeball looked shrunken or smaller than the fellow eye The three main tests that are used to confirm the diagnosis of Horner's is :
1. The Cocaine test. This is a fairly definitive test whereby the pupil which usually dilates from the use of cocaine, does not.
2. The Paredrine test - (hydroxyamphetamine 1%)
3.The Dilation Lag Test.
In most cases, unequal pupil size is idiopathic, that is , there are no know causes, but to be sure, consult with a neurologist and neuro-ophthalmologist. Hope this helps
Dr. Ken
