Different pupils in a child

Pupils of different sizes

Pupils of different sizes can be a manifestation of an ophthalmologic or neurological disease.

Also, this pathology is called anisocoria, as seen in the photo, while the person has pupils of different diameters. Usually, one eye reacts to light, while the second remains fixed. The norm is the difference in the diameter of two pupils no more than 1 mm. Outwardly, it is completely invisible.

Different pupils in a child

Types of anisocoria

  • physiological. If the difference between the pupils is 0.5-1 mm and the diagnosis does not reveal any diseases, then this condition refers to the physiological anisocoria and is regarded as an individual feature of the organism. According to statistics, this feature occurs in one-fifth of people.
  • congenital This species develops due to defects in the visual apparatus, while the eyes may have different visual acuities. Also, the causes may be impaired development or damage to the nervous apparatus of the eyes.

Different pupils in a child

Anisocoria in a child

Sometimes a child is born in a family with different pupils, if any of the relatives had similar abnormalities, then most likely it is genetic and there is no reason for concern.

Such a hereditary feature occurs immediately after childbirth and does not lead to a delay in emotional or mental development. Often in children the hereditary difference in the diameter of the pupils passes by 5-6 years of age, but in some cases it may remain throughout life.

Sometimes the presence of pupils of different sizes is a manifestation of Horner’s syndrome, then the omission of the eyelids is connected to the anisocoria, usually over one eye, where the pupil is narrower.

Causes of anisocoria in newborns

More frequent causes are impaired development of the autonomic nervous system of the infant or hereditary pathology of the iris. If the difference in the diameter of the pupils appeared suddenly, then this may be a manifestation of the following pathologies:

  • brain tumor;
  • cerebral aneurysm;
  • brain contusion;
  • encephalitis.

Causes of adult anisocoria

  1. brain aneurysm.
  2. traumatic brain injury and concomitant bleeding.
  3. diseases of the oculomotor nerve.
  4. migraine, in this case, the different diameter of the pupils does not last long.
  5. neoplasm or abscess of the brain.
  6. various infectious processes in the brain (encephalitis, meningitis).
  7. glaucoma, increased pressure in one of the eyes may cause
  8. the use of certain drugs, such as eye drops, can cause a reversible difference in pupil size.
  9. horner’s syndrome. A neoplasm in the lymph node located at the top of the chest can cause a strong anisocoria, as well as the omission of the eyelid.
  10. Roque syndrome – the cause of lung cancer.
  11. eye injury with damage to the muscles responsible for the contraction and expansion of the pupil.
  12. cerebral circulation disorder.
  13. thrombus in the carotid artery.
  14. inflammatory diseases of the eye (iridocyclitis, uveitis).
  15. hereditary anomalies of the development of visual organs.

When necessary, urgently consult a doctor

It is very important to go to the doctor as soon as possible if you have a sudden or gradual change in the diameter of the pupils, which cannot be explained and which does not pass for a long time. This can be a manifestation of very serious diseases. The following manifestations should be alerted to the anisocoria: fever, loss of vision, double vision, photophobia, pain in the eyes or headache, sudden loss of vision, vomiting or nausea.


As additional methods to clarify why anisocoria appeared, can be used:

  1. EEG.
  2. x-ray of the lung.
  3. ophthalmoscopy.
  4. magnetic resonance imaging of the brain, with the introduction of a contrast agent.
  5. diagnostics of spinal fluid.
  6. registration of intraocular pressure.
  7. dopplerography of cerebral vessels.

Anisocoria treatment

Treatment depends entirely on the identified causes of this pathology. If it is a hereditary or physiological condition, then therapy is not necessary. If the cause is infectious or inflammatory processes, then treatment is prescribed for the corresponding nosology. Prescribe local or systemic antibiotics. For tumor processes, surgical treatment.

Different pupils in a child

Pupils of different sizes can be a manifestation of various pathologies, so it is better not to postpone a visit to the doctor.

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