eye disorders
Unequal Pupils
Evaluation of Unequal Pupils
Doctors' first goal is to determine whether the pupils have always been unequal or whether there is another cause such as a medication, chemical, or disorder. Then the goal is to decide whether the larger or the smaller pupil represents the problem. The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation. In people with unequal pupils, certain symptoms and characteristics are cause for concern. They include Drooping eyelid (ptosis) Double Vision None Sudden Vision Loss None Headache or neck pain Eye Pain None Recent Overview of Head Injuries or People with warning signs should see a doctor right away. People without warning signs but who have any other symptoms should call the doctor. The doctor can decide how quickly they need to be seen based on their symptoms. People who simply happen to have noticed unequal pupils and feel well can usually wait a week or two to see a doctor. Doctors first ask questions about the person's symptoms and medical history, including questions about smoking. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the unequal pupils (see table) and the tests that may need to be done. Doctors ask when the person noticed the unequal pupils, whether vision is blurred in the light or dark, and whether the person has any other symptoms. Other important symptoms involving the eyes include a droopy eyelid, double vision, pain with bright light, loss of vision, and eye pain. Other important symptoms that do not involve the eyes include headache, dizziness or loss of balance, cough, chest pain, or shortness of breath. Doctors ask whether the person has recently had a head or eye injury, what eye drops the person has used, and whether the person has ever had an eye disorder or eye surgery. The physical examination focuses on the head and eyes. Doctors examine the person's pupils in light and dark rooms. They examine whether the eyes move normally when the person follows a doctor's finger moving up, down, left, right, and toward the eyes. Doctors examine the entire eye, usually using a What Is a Slit Lamp? (an instrument that enables a doctor to examine the eye under high magnification). Other eye symptoms are evaluated as necessary. Doctors may use eye drops to test how the pupils respond to medications that cause the pupils to constrict or widen. Sometimes doctors examine an old photograph of the person (for example, on the person's driver's license) to see whether pupils were previously unequal or the eyelid(s) droopy. Typically, people with eye symptoms such as pain, redness, blurry vision, or light sensitivity have an eye disorder. People who have a droopy eyelid, double vision, headache, or balance difficulties have Horner Syndrome or Testing is usually unnecessary unless people have other symptoms. People with Horner Syndrome or 