Always see a physician immediately if the pupil size differs with:. If you have a different-sized pupil after an eye or head injury, see a doctor immediately. If there is a recent change in the pupil's size, it may be a sign of a very serious illness. Contact a physician if you have persistent, unexplained, or sudden changes in pupil size. Your ophthalmologist is committed to protecting your eyesight. If you have any questions about anisocoria, ask your ophthalmologist. If the anisocoria is related to an eye health problem, this problem will need to be treated. Typically, anisocoria does not need to be treated because it does not affect eyesight or eye health. This is because a hemorrhage, tumor, or other intracranial mass may enlarge to a size where the third cranial nerve (CN III) is compressed, resulting in uninhibited dilation of the pupil on the same side as the lesion. Anisocoria is confusion, decreased mental status, severe headaches, or other neurological symptoms that may signal a Neurosurgical emergency. These cases may be due to brain mass lesions that cause oculomotor nerve palsy. It should be considered an emergency if a patient develops acute anisocoria. Old photographs of patients' faces often help diagnose and establish the type of anisocoria. Anisocoria is usually a mild finding, not accompanied by other symptoms. This is because Horner's syndrome and oculomotor nerve damage both cause ptosis. If the examiner is uncertain whether the abnormal pupil is the constricted or dilated pupil, and if unilateral drooping of the eyelid is present, the abnormally sized pupil can be presumed to be the one on the side of the ptosis. Some causes of anisocoria are life-threatening, including Horner's syndrome and oculomotor nerve palsy. A Relative Afferent Pupillary Defect (RAPD) also known as Marcus Gunn's pupil does not cause anisocoria. This may suggest a toned Adie pupil, pharmacologic dilation, oculomotor nerve palsy, or damaged iris. Anisocoria which is larger in bright light suggests that the larger pupil is the abnormal pupil. If the smaller pupil dilates in response to the instillation of apraclonidine eye drops, this suggests Horner syndrome. In Horner's syndrome, the sympathetic nerve fibers have a defect, so the pupil of the involved eye does not dilate in the dark. Anisocoria that is aggravated in the dark suggests that the small pupil is the abnormal pupil and suggests Horner's syndrome or mechanical anisocoria. 
Clinically, it is important to determine whether anisocoria is more noticeable in dim or bright light to clarify whether the larger or smaller pupil is the abnormal one. The causes of anisocoria range from mild to life-threatening conditions.Brain disorders associated with anisocoria include stroke, hemorrhaging, and, less commonly, certain tumors or infections. People with nervous system disorders that cause anisocoria often also have a droopy eyelid, double vision, or strabismus.One of the most important is Horner's syndrome. Neurological disorders: Several conditions that damage nerves in the brain or spinal cord can cause anisocoria.But it can be associated with eye trauma, lack of blood flow, or infection. In most cases, the cause of Adie's pupil is unknown. The affected pupil also does not respond to light.
Adie's tonic pupil: This benign condition usually makes one pupil noticeably larger than the other.Inflammation of the iris: Iritis can cause anisocoria, which is usually accompanied by eye pain.
Certain eye medications: For example, pilocarpine eye drops used to treat glaucoma may make the pupil of the treated eye smaller than the other pupil. Significant anisocoria can have many causes, and some can be medical problems. The prevalence of anisocoria did not vary with time of day or day to day nor was it influenced by the subject's sex, age, or eye color. Usually, those cases of anisocoria where one pupil is larger than the other by less than 1.0 mm with no apparent cause are called simple anisocoria, benign anisocoria, or physiological anisocoria. Many cases of mild anisocoria are normal and have no underlying disease or history of trauma. People who can get anisocoria include those who have: Sometimes, however, uneven pupil size can be a symptom of a serious eye problem. In fact, one in five people have pupils who are normally different heights. Anyone can have students of different sizes with no problem. The pupil allows light to enter the eye so that you can see. Anisocoria occurs when the pupils in your eye are not the same size.
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