RT Book, Section A1 Lueder, Gregg T. SR Print(0) ID 56150531 T1 Chapter 18. Anisocoria T2 Pediatric Practice: Ophthalmology YR 2011 FD 2011 PB The McGraw-Hill Companies PP New York, NY SN 9780071633802 LK accesspediatrics.mhmedical.com/content.aspx?aid=56150531 RD 2024/03/28 AB Table Graphic Jump Location|Download (.pdf)|PrintThe Problem“One of my child’s pupils is larger than the other.”Common CausesPhysiological anisocoriaHorner syndromeIritisPharmacologicalOther CausesThird nerve palsyTraumaCongenital iris anomaliesKEY FINDINGSHistoryPhysiological anisocoriaMild asymmetryVariable (pupils sometimes equal)Horner syndromePupils always unequalWorse in dim lightPtosis on side of smaller pupilPossible decreased sweating of face on affected sideUnequal pupil color in congenital or early acquired casesAssociated with some systemic disordersNeuroblastomaThoracic or cervical surgeryBirth trauma with cervical injuryTraumaHistory of direct ocular injuryIritisHistory of juvenile idiopathic arthritisOcular pain, rednessPharmacologicalExposure to topical medications or plants that affect pupilThird nerve palsyStrabismus, ptosisSystemic diseases associated with third nerve palsyExaminationPhysiological anisocoriaDifference between pupils less than 1.0 mmVariable, sometimes equalGreater in dim lightHorner syndromeAsymmetry greater in dim lightMild ptosis on affected sidePossible unequal sweating on affected sidePossible difference in iris pigment (heterochromia)TraumaAffected pupil may be smaller or larger than normal pupilOther signs of ocular traumaIritisPupil nonreactive, possibly irregularPossible cataract