What to do with pupils of different sizes? Different pupils Different pupils in the dark.

The human pupil is a special structure of the eye, which is formed by the cornea and muscles. eyeball. In fact, this is just a hole in the cornea, the diameter of which is regulated by muscle structures. Its main task is to regulate the light flux that enters the retina. This is achieved by dilating or constricting the pupil.

The pupillary reflex, depending on the degree of light hitting the retina of the eyeball, regulates the diameter of the pupil, and also synchronizes both pupils over time. This reflex is controlled by the brainstem. Most often, the pathology of the brain stem causes the pupils of the eyes of different sizes.

The sympathetic nervous system causes large pupils. This is observed during a period when a person experiences fear, anger or excitement. The parasympathetic nervous system, on the contrary, causes constriction - the pupils of the eyes are narrow. Normally, these two systems are antagonists to each other.

In medicine, different pupils of the eyes that are detected in a patient are referred to as anisocoria.

Causes of different pupils of the eyes in an adult

There are not many conditions when anisocoria occurs in an adult. They are either harmless temporary conditions, or they indicate a serious pathology of the brain and optic nerves. The main reasons for the development of this condition are:

• 1. Injury to the brain, skull in the area of ​​the base (concussion or contusion of the brain, fracture of the base of the skull);
• 2. Injury to the eye, hemophthalmos (blood entering the vitreous body);
• 3. Cerebral edema;
• 4. Cerebral infarction (stroke), localized in the trunk area;
• 5. The use of drops containing M-anticholinergics (atropine, etc.). Such drops are used to relax the muscles of the eye, dilate the pupil in order to conduct a detailed examination of the retina;
• 6. Burn of the retina of one eye, which leads to blepharospasm. This condition can be observed when a person looks at bright light (especially sunlight) without protective equipment;
• 7. Poisoning by various substances (including drugs);
• 8. Clinical and biological death. In this case, there is also a lack of breathing and heartbeat;

When the pupils are different and the causes of this condition are established, the doctor will be able to begin adequate treatment. If the patient's condition is not severe, and anisocoria is caused by non-drug causes, the visual acuity of a person must be determined without fail. In a serious condition, mainly with brain pathology, the main thing for doctors is the life of the patient and the maintenance of the basic vital functions of the body, as well as the maximum preservation of brain functions.

Pupils of different sizes in a child

If the baby has pupils of different sizes, then most often this indicates congenital anomaly development of the brain or visual analyzers. Usually such conditions are detected immediately after childbirth. At the same time, symptoms of hydrocephalus, a decrease in the size of the brain (microcephaly) are observed according to the results of ultrasound.

Different rounded pupils in a child (including a baby) can appear for the same reasons as in adults. However, the prevailing mechanisms for the development of this condition are head or eye injuries, poisoning with various toxic substances (plants containing anticholinergics play a special role in this process).

Sometimes the difference in the eyes of a child is associated with children's games and attempts to shine into each other's eyes with various flashlights, laser pointers, etc. In this case, the different size of the pupils are quickly leveled - and they become equal in diameter and rounded.

If the child's pupils differ in diameter, then this anomaly is called anisocoria. Anisocoria in children does not always indicate the presence pathological process. According to acceptable standards, the difference in diameters can reach 1 mm. It is possible to assume the presence of pathology if the child has one pupil larger than the other with a difference of more than 1 mm or when one of the pupils does not respond to light.

You can determine which pupil is not functioning properly as follows:

Pupils dilate in the dark. That eye, the pupil of which did not expand properly or remained unchanged at all, does not function correctly.

In the light, the pupils constrict. After exposure to the eyes with a light beam, the pupils should evenly decrease (narrow). The pupil, which is larger in size, indicates pathology.

It is almost impossible to understand why one pupil does not change its size under the influence of light on its own. The reasons can be very different, and some require special diagnostics to find out.

Pupils of different sizes in a child can be observed due to a hereditary factor. If the closest relatives have the same anomaly, then most likely, the difference in pupils is due to a genetic feature. To exclude the possibility of complications, it is recommended that the child be taken for an examination to confirm the absence of danger.

Other causes of the anomaly:

1. Inflammatory processes of the eye or a violation of proper performance optic nerve contribute to the development of anisocoria. Under the influence of the inflammatory process, muscle malfunctions occur.
2. Injury to the head as a result of falling and hitting a hard object. Damage to the cranium can lead to compression of the brain by a hematoma. Even a minor head injury can trigger the development of the disease. Head trauma and anisocoria occur during the passage of the baby through the birth canal.
3. Damage to the muscles of the iris under mechanical action (eye injury).
4. Diseases of the brain or brain stem: aneurysm, tumor, edema.
5. Medical anisocoria. Some medications, such as eye drops, can affect pupil size. Pupil mismatch normalizes after the cessation of exposure to or intake of these substances.
6. Poison poisoning.
7. neurological diseases.

Anisocoria is not always accompanied by a deterioration in the quality of vision. In the event that this pathological process is running, the threat of a complete loss of the ability to see increases every day. Delay in diagnosis and provision of appropriate assistance can cause irreparable damage to human health.

Toddlers and anisocoria

The causes of anisocoria in newborns are the same as in children. preschool age, teenagers or.

With a congenital anomaly of a pathological nature, the baby may have deviations in the work of the vegetative nervous system or abnormal development of the iris. A newborn is immediately born with such a pathology. It does not cause additional symptoms that affect the behavior of the child. In addition to such a symptom, as one pupil is larger than the other, the crumbs may experience eyelid drooping or strabismus.

If all probable causes of the pathological nature of anisocoria in infants have been excluded, but there is a difference in the size of the pupil diameter, it is considered that the pathology is congenital. According to statistics, the size of the diameter of the pupils of the right and left eyes with a congenital anomaly disappears by the age of 5. It is not excluded that such a feature will not pass, but will remain for life.

With congenital anisocoria, which does not have a pathological cause of its origin in children, in addition to the fact that one pupil differs in size from the other, a different eye color can be observed.

In the event that parents notice that the baby has one pupil larger than the other, it must be shown to the doctor.

Pathology may occur as a result of the following circumstances:

• After falling and hitting the head on a hard object. In infants, the bones of the skull are not yet strong enough. The percentage of injuries with aggravating consequences at such a young age is quite high.
• Brain tumor (malignant, benign). The causes of neoplasms in the brain can also be triggered by the result of a fall, even from a small height. It is not always possible to find out the reason why a tumor has formed.
• Meningitis and encephalitic tick bite. Symptoms do not appear immediately after the bite, but after a few days. In addition to anisocoria, the patient feels lethargic and lethargic.
• A bulge in the wall of a blood vessel is an aneurysm. In addition to anisocoria, this pathology can lead to cerebral hemorrhage.
• Andy Syndrome. The reasons for its occurrence are not yet fully understood. In addition to the different size of the diameter of the pupils, their deformation is observed. After exposure to the affected eye with a light beam, the reaction may be completely absent or a delayed process of convergence can be observed.

What to do in case of anomaly

In a situation where, after a head injury or for another reason, one pupil has become smaller or larger from the other, the child should be taken to a specialist. Even a temporary deviation from the norm does not guarantee that global changes that could threaten health have not occurred in the body. Only after a series of necessary tests is the final diagnosis made, which indicates the need for treatment.

The principle of any treatment is to eliminate the root causes of abnormal size and reaction of pupils to light.

If, after diagnosis, it was confirmed that the anomaly is congenital or does not pose a threat to the patient, then there is no need to treat different pupil diameters.

In some circumstances, conservative treatments may not be enough. Rejection surgical intervention may result in loss of vision.

The prognosis in the presence of this anomaly will depend on its cause, the individual characteristics of the child and compliance with all the recommendations of the ophthalmologist and other specialists that may be involved in the process of diagnosing and making a diagnosis.

Anisocoria is called different sizes of pupils, while one of them gives a normal reaction to changes in lighting, and the second is fixed in one position.

If parents reveal such a sign in their child, then this can be a cause for great concern. However, it should be remembered that such a phenomenon does not always directly indicate any pathology. If the pupil of one eye differs from the other by no more than 1 mm, then in this case it can be considered the norm and is called physiological anisocoria. It is observed in 20% of absolutely healthy people.

It should be noted that the pupil is not a separate anatomical formation, it is simply a part of the iris of the eye that completely absorbs color. With a high background of illumination, a protective reaction occurs - the pupil narrows, and in the dark it increases, regulating the flow of light particles entering the eye.

Such work is carried out by two types of iris muscles - circular and radial, their contraction or relaxation changes the diameter of the pupil. The muscles themselves receive signals from the retina. Under normal conditions, these muscles work in the same way. If one of the pupils gives an abnormal reaction, then this is anisocoria.

Anisocoria as a symptom of the disease

Anisocoria is not a separate nosological unit, an independent disease. But this is a sign of trouble that cannot be overlooked.

Anisocoria in a child can be acquired and congenital. Congenital pathology is associated, most often, with a violation of the structure of the iris. Very rarely, such a phenomenon is observed with underdevelopment of the brain in combination with appropriate neurological symptoms and developmental delay in the future.

Acquired forms of anisocoria develop due to pathology of the iris (ocular causes) or may occur with disorders associated with the nervous system (non-ocular causes). There is also a division of such a phenomenon as anisocoria into unilateral and bilateral, but last option is extremely rare.

Anisocoria in infants is most often found in trauma during childbirth of the cervical spine, less often as a result of traumatic lesions of the eyeball and inflammatory eye disease.

Often there are problems that are accompanied by anisocoria in older children. Ultimately, this leads to disruption of the muscles of the iris:

1. Inflammatory processes provoke infiltration between fibers, and inflammatory mediators change the ionic composition of muscle fibers. This reduces their speed.
2. Traumatic injuries of the eyeball. It leads to a direct violation of the integrity of the fibers of the circular or radial muscles and causes their death. The cause can also be the high intraocular pressure that occurs during an injury. This leads to mechanical impact and impaired coordination of muscle work and a decrease in their contractile function.
3. Skull trauma. The newborn often manifests anisocoria with hematoma due to birth trauma. It produces pressure on the brain and disrupts the nervous regulation of the pupils.
4. Diseases of the brain or bundles of the visual analyzer. This breaks the feedback between the retina and pupil. Due to the fact that the structural features of neural connections in a child are in a developing stage and their final formation occurs only by about six years, and also due to the mobility of the cranial bones, the influence of processes that cause an increase in intracranial pressure in young children rarely call anisocoria. In addition, pronounced degenerative or tumor processes are mainly observed in the elderly, therefore, in childhood this occurs most often in cases of congenital infection nerve pathways in neurosyphilis.
5. Medical anisocoria. The difference in the size of the pupils can occur as a result of instillation with special preparations for the study of the fundus, such effects are typical when anticholinergics enter the eye. After a while, this disappears as soon as the drug stops working.

The cause of anisocoria in children may be a hereditary factor. In order to find out, it is enough to ask your closest relatives about the presence of such a phenomenon. In this case, it is determined by a genetic predisposition and sometimes remains forever, but may eventually pass.

Signs of illness in children

However, if a child has congenital anisocoria, especially when it progresses or is combined with neurological symptoms, then it is necessary to consult an ophthalmologist and neurologist who will conduct a detailed examination and be able to confirm or exclude possible pathological processes.

It is especially important to immediately undergo an examination if, together with a change in the size of the pupils, phenomena such as:

• headache;
• decreased visual acuity;
• nausea and vomiting;
• the occurrence of fuzzy images or doubling;
• feverish symptoms;
• photophobia.

Neurological causes that cause such a symptom can manifest themselves in different ways. Increased anisocoria in bright light indicates that the sympathetic innervation of the eye predominates, this is accompanied by mydriasis (dilation of the pupil), this is due to damage to the oculomotor nerve.

Additional symptoms with such a violation are limited eye mobility, double vision, divergent strabismus. In this case, a larger pupil is abnormal.

The defeat of the sympathetic innervation is manifested in increased anisocoria in a dark room. Often this occurs with damage to the brain stem structures and may be accompanied by drooping of the eyelid. At the same time, accommodation and convergence remain normal. An abnormal reaction occurs in the pupil, which is smaller in diameter - it does not expand in the dark.

Only with a timely appeal to specialists is it possible to detect a pathological condition that causes anisocoria at its early stage, with the involvement of all modern species diagnostics, including MRI, which can significantly affect the course and effectiveness of further treatment. No lotions, baths and other folk remedies are able to help with anisocoria.

The baby cannot talk about his problems, so the mother has to pay Special attention the way he looks. If the baby feels bad, it is always noticeable in his eyes. They appear dull and tired. But it also happens that parents find different pupils in the baby. Is it dangerous? This phenomenon can be both an individual feature of the child, and a sign of the disease.

The pupil is a hole in the center of the iris, necessary to regulate the flow of sunlight that penetrates the visual analyzer and hits the retina. Its contraction and expansion are controlled by the nervous system.

In strong light, the circular muscle of the iris (sphincter) tenses, and the hole decreases, due to which part of the beam flux is removed. The fall in the light level leads to relaxation of the radial muscle (dilator), and the pupil increases in diameter.

In addition to light irritants, the following changes in the size of the pupils lead to:

• pain;
• experiences;
• sharp sounds;
• fright.

A person cannot control the work of the pupils. All processes occur reflexively and symmetrically: if you direct a flashlight into one eye, both holes in the irises will decrease with a discrepancy of 0.3 mm.

Causes of different pupils

In young children, the pupils are usually enlarged, but evenly. The condition in which their diameters differ is called anisocoria. If the difference is less than 1 mm, and there are no pathological manifestations, this is considered a variant of the norm.

Physiological anisocoria is observed in 20% of people from birth and is usually hereditary. By the age of 5-6, it can disappear without a trace.

Pathological anisocoria occurs due to an imbalance in the work of the muscles of the eye. Why is this happening? The most common reason is the use eye drops or accidental contact with the conjunctiva of certain drugs. In addition, medications with a narcotic effect can lead to uneven expansion of the pupils. The diameters of the holes in the iris become the same after the cessation of use and withdrawal from the body of drugs.

The remaining causes of anisocoria can be divided into ophthalmic and related to the work of the central nervous system. Main ophthalmic factors:

1. congenital insufficiency of the eye muscles, which may be accompanied by strabismus or decreased visual acuity;
2. injuries accompanied by damage to the iris, muscles and nerve fibers;
3. iridocyclitis - inflammation of the ciliary body and iris;
4. glaucoma - an increase in pressure inside the eye (very rare in children);
5. herpetic eye disease.

Neurological causes of anisocoria in infants:

• damage to the cervical spine during childbirth;
• fast growing tumor in the brain;
• aneurysm;
• hemorrhage in the brain;
• meningitis;
• neurosyphilis;
• encephalitis;
• traumatic brain injury;
• tuberculosis;
• carotid thrombosis.

Violation of the work of the pupils in these pathologies occurs due to squeezing of the nerve responsible for the movement of the eyes, or damage to the visual zones of the cerebral cortex. These conditions are always accompanied by other symptoms of trouble, upon detection of which one should urgently seek medical help. Possible manifestations:

1. increase in body temperature;
2. vomit;
3. restless behavior and a sharp cry due to pain;
4. neck muscle tension;
5. weakness, apathy, drowsiness;
6. photophobia;
7. blurred vision, and so on.

Anisocoria may be one of the hallmarks of Horner's syndrome. In infancy, this disease is most often congenital or develops due to trauma to the cervical spine during childbirth. Its symptoms result from compression of the sympathetic nerve and damage to the eye muscles. The main signs (appear on one side of the face):

• anisocoria with a delay in the expansion of one of the pupils;
• drooping eyelid (ptosis);
• retraction of the eyeball;
• different color of the irises (not always observed);
• no sweating on the face.

Diagnostics

Noticing anisocoria in a child, you should contact an ophthalmologist. The doctor must check the reaction of pupils to light, examine the eyes for injuries and inflammation, and assess intraocular pressure using tonometry. He can also conduct pharmacological tests - instill certain medicines and assess the condition.

If the ophthalmologist suspects the development of a neurological disease, they will refer the baby for examination to a neurologist, which may include:

• checking reflexes;
• Ultrasound of the brain (until the fontanel closes);
• CT, MRI or X-ray of the brain, chest, cervical spine.

When symptoms are found infectious disease blood tests are carried out (general, bacteriological, for antibodies). In addition, a lumbar puncture may be needed to collect cerebrospinal fluid (in the case of meningitis).

Treatment

The tactics of treating anisocoria depend on its causes, which are determined during the diagnosis. If the child does not have any diseases, and his vision is not impaired, he is monitored, which implies periodic visits to the ophthalmologist.

Directions of therapy:

1. imbalance in the work of the oculomotor muscles, including with Horner's syndrome - myoneurostimulation of problem areas with current to improve their tone, surgery in the presence of astigmatism;
2. infectious diseases - the use of immunostimulants, vitamins, antibiotics or antiviral agents;
3. brain tumors, trauma, hemorrhages - surgery;
4. inflammatory eye pathologies - local and / or systemic antibiotic therapy;
5. injuries of the cervical spine - massage, physiotherapy and so on.

In parallel with the main treatment, the doctor may prescribe special drops that relieve spasm of the eye muscles. This helps to normalize the work of the pupils.

Different pupil size in a child is a symptom that can be caused by various conditions. Most often, anisocoria is a congenital feature that resolves with age and does not affect vision. But the baby should be shown to the ophthalmologist. It is especially important to seek help if there are other pathological manifestations. Modern methods therapy can correct the work of the oculomotor muscles, but it is important to identify the underlying disease and treat it.

Every mother after the birth of a baby is happy to watch his development. Any changes do not pass by her attentive gaze. That's the first time he smiled, that's the first time he said: "Agu."

But ... different pupils in a child? What is this? dangerous disease? Will it go away or stay forever? These questions burst into the mind of the mother. And really, what can this phenomenon mean? Let's start to figure it out...

Why do pupil sizes vary?

Yes, at first glance, this may seem like a terrible and serious disease, but you should not immediately panic. Firstly, this is not such a rare phenomenon in children and is called anisocoria. Secondly, it is considered normal if the pupils differ in size by no more than 1 mm, regardless of the lighting. It is also not worth letting anisocoria in a baby take its course, as it can be a sign of serious illness.

The main reasons for its occurrence:

1. Heredity. Oddly enough, but different pupils can be inherited. If one of the family members has this, then you should not worry - this is a harmless genetic inheritance. You can ask a relative about this and make sure that anisocoria does not interfere with living a full life.
2. Incorrect work of the muscles of the iris. We all know that pupils react to light: the brighter the light, the narrower the pupil. And if the size of the pupils is different, this may mean that the constrictor muscle of the iris of one eye is not working properly. That is, the pupil seems to narrow, and then expand again and stop responding to light.
3. Medications. Perhaps the baby is instilled with eye drops. They can cause such an effect, after the cessation of use, the pupils will return to normal.
4. Damage to the oculomotor nerve. Often accompanied by dilated pupil on the affected side. In this case, there may be a restriction of eye movement, divergent strabismus, diplopia and ptosis. Nerve compression occurs due to aneurysm, tumor development, intracranial pressure. Another cause of compression is damage to the ciliary ganglion due to infection (for example, herpes zoster). In this case, the pupil has no reaction to light, but delayed accommodation is maintained, that is, when looking into the distance, the pupil expands very slowly.
5. Injury. In infants, different pupils can be the result of an injury (fall, bruise) or infection.

If anisocoria is accompanied by nausea, vomiting or other non-ocular symptoms, you should immediately consult a doctor!

Horner's syndrome or simple anisocoria

A very rare disease, the basis of which may be compression of the sympathetic nerve in the chest or neck, paralysis of the eye muscles. Anisocoria in Horner's syndrome is a delay in the expansion of one pupil.

If you illuminate your face with a flashlight, and then turn off the light, you can watch how this happens. At first, the pupils will be distinctly different from each other, in the dark it will be clearly visible for only 5 seconds, after which the difference will decrease, since the pupil will still expand.

In addition to anisocoria, there may be:

• ptosis - drooping of the upper eyelid;
• miosis - constriction of the pupil (most often noticeable in the dark);
• pseudo enophthalmos - apparent retraction of the eyeball;
• anhidrosis is the absence of sweat on the face.

The reasons for the development of Horner's syndrome are not known for certain, practice shows that these are mainly malfunctions in the activity of the nervous system. As well as osteochondrosis, damage to the trigeminal nerve, spinal injuries, malignant tumors, strokes and migraine attacks. However, this is more common in adults.

In young children, Horner's syndrome is mainly a congenital pathology. It can also be caused by birth trauma. In such cases, the iris on the affected side is always lighter. Even if there was no birth injury, a thorough examination (CT and MRI) may be needed to find out the reasons.

With the development of heterochromia (different color of the iris), a chest x-ray, a tomogram of the head and neck, a daily catecholamine test for neuroblastoma, a malignant tumor of the sympathetic nervous system, are prescribed.

What to do if anisocoria is detected in an infant?

If it became noticeable that the baby has different pupils, then the first thing to do is to go to an appointment with an ophthalmologist. If necessary, see a neurologist. If the child has no pathologies, then it remains only to observe him.

In other cases, treatment is directed at eliminating the causes of anisocoria. For example, with Horner's syndrome, the main direction is to get the eye muscles to work. For this, the method of myoneurostimulation is used. Its essence is the impact of current on the affected nerves and muscles to increase their tone. This contributes to the restoration of accommodation, but the ability of the pupil to narrow is not restored.

If anisocoria is combined with astigmatism in older children, surgical treatment may be indicated. However, quite often, treatment is not required, and when a child reaches a certain age, it disappears without a trace.

Why is it so important to examine children with an ophthalmologist from the first months of life? Video for parents:

Have you encountered a similar problem? How did you find the solution? Tell us about it! Perhaps your comment can help other users!

Anisocoria is a condition in which the pupils of the right and left eyes differ in size or diameter. The pupil is the round black area in the center of the iris. Depending on the lighting, it can have dimensions from 1mm to 6mm in diameter.

In the presence of a general or ocular pathology, anisocoria is always combined with the following manifestations:

• restriction of eye movement, or an eye in which the pupil is larger
• drooping of the upper eyelid (ptosis)
• Pain in the eyes
• fever or fever
• headache
• decreased vision
• double vision

Causes of anisocoria

There are two types of anisocoria:

• physiological. Normally, every fifth person has a slight difference in the size of the pupils.
• pathological. Eye diseases that can lead to anisocria: glaucoma, inflammatory diseases of the eye (iritis, uveitis), eye tumors
• pathological with common diseases human: viral infection, syphilis, brain tumors, paralysis cranial nerves, Horner's syndrome, migraine, brain aneurysm.

When should you urgently see a doctor?

Anisocoria can be a sign of very serious diseases that require urgent medical care.

Therefore, consult a doctor if you experience the following symptoms:

• temperature increase
• Strong headache
• nausea and dizziness
• double vision
• drooping and swelling of the upper eyelid

If you have suffered a head injury and the pupils of your eyes have become of different sizes, be sure to consult a doctor.

How to treat anisocoria

Physiological anisocoria does not affect vision and eye health. Therefore, it does not need treatment.

In pathological anisocoria, the cause of the appearance of different pupils is first identified. Then the treatment is carried out.

For example, with a brain infection, treatment is carried out in a specialized hospital. A course of antibiotics and antiviral drugs is prescribed.

Head tumors and aneurysms of the vessels of the head require surgical treatment.

With glaucoma, treatment is carried out aimed at normalizing eye pressure and preventing the development of glaucoma attacks.

At inflammatory diseases eyes are treated with antibiotics.

Surgical treatment is indicated for eye tumors.

What absolutely should not be done with anisocoria

When a symptom of different pupils appears, you should not:

• instill drops on your own, which can affect the size of the pupils

What happens if the symptom of anisocoria is not treated

In the case of physiological anisocoria, treatment of the symptom is not required.

The presence of pathological anisocoria indicates serious diseases of the eyes or head. Therefore, if the cause is not identified and treatment is started on time, serious complications and the development of conditions that threaten the life of the patient are possible.

Prevention of anisocoria

There are no specific measures to prevent anisocoria. However, you can reduce your risk of developing this condition by using protective equipment when playing contact sports.

Pupils of different sizes - the sight is not the most familiar. Therefore, parents of children who have such an asymmetry are justifiably alarmed. Is anisocoria dangerous and why it occurs, we will tell in this article.

What it is?

The difference in the size of the pupils in the language of physicians is called anisocoria. This is by no means an independent disease, but only a symptom of some disorder in the body.

Therefore, it is not the symptom itself that should be identified and treated, but the true cause, which led to the fact that the pupils acquired a different diameter.

The pupil was created by nature and evolution so that the amount of rays falling on the retina is regulated. So, when bright light enters the eyes, the pupils constrict, limiting the number of rays, protecting the retina. But in low light, the pupils dilate, which allows more rays to hit the retina and form an image in conditions of poor visibility.

With anisocoria for a number of reasons one pupil stops working normally, while the second one functions in accordance with the norms. In which direction the “sick” pupil will change - will it increase or decrease, depends on the causes and nature of the lesion.

Causes

The causes of asymmetric pupil diameter in a child can be different. This is physiology, which is quite natural under certain circumstances, and pathologies, and a genetic feature that the baby can inherit from one of the relatives.

Physiological

Such completely natural causes of imbalance are usually observed in one in five children. At the same time, for many children, the problem goes away by itself closer to 6-7 years. The dilation of the pupil can be affected by the intake of certain medications, for example, psychostimulants, severe stress, vivid emotions, the fright that the child experienced, as well as insufficient or unstable lighting, where the child spends most of the time.

In most cases, there is symmetrical decrease or increase in pupils relative to the norm, but this does not always happen. And then they talk about physiological anisocoria. It is quite simple to distinguish it from pathology - it is enough to shine a flashlight into the child's eyes. If both pupils react to a change in light, then there is most likely no pathology. In the absence of one pupil to change the intensity of artificial lighting, they speak of pathological anisocoria.

The physiological difference between pupil diameters is no more than 1 mm.

Pathologies

With pathological causes, one pupil is not just visually larger than the other, the functionality of the pupils changes. A healthy one continues to respond adequately to light tests, to changes in lighting, to the release of hormones (including fear, stress), and the second one is fixed in an abnormally expanded or narrowed position.

Congenital anisocoria in infants may be the result of a violation of the structure of the iris.

Less commonly, the cause lies in the underdevelopment of the brain and dysfunction of the nerves that set in motion oculomotor muscles, sphincter pupil.

An acquired problem in babies can be a consequence of a birth injury, especially if the cervical vertebrae were injured. Such anisocoria is already diagnosed in a newborn, as is the genetic asymmetry of the pupils.

Pupils of different sizes can be a sign of traumatic brain injury. If the symptom first manifests itself precisely after a fall, hitting the head, then it is considered one of the main ones in the diagnosis of traumatic changes in the brain. So, by the nature of anisocoria, it is possible to determine which part of the brain is subjected to the most severe pressure in case of cerebral hematoma, with brain contusion.

Other reasons

Other causes of occurrence:

Taking narcotic drugs. In this case, parents will be able to notice other oddities in the behavior of their child (usually adolescence).

Tumor. Some tumors, including malignant ones, if they are located inside the skull, may well put pressure on the visual centers during growth, as well as interfere with the normal functioning of the nerve pathways through which the brain receives a signal to the organs of vision to narrow or expand the pupil, depending on the surroundings. conditions.

infectious diseases. Anisocoria can become one of the symptoms of an infectious disease, in which the inflammatory process begins in the membranes or tissues of the brain - with meningitis or encephalitis.

Eye injury. Anisocoria is usually caused by blunt trauma to the pupillary sphincter.

Diseases of the nervous system. The pathology of the autonomic nervous system, in particular, the cranial nerves, the third pair of which is responsible for the ability of the pupil to contract, can lead to asymmetry in the diameters of the pupils.

Diseases that cause anisocoria:

Horner's syndrome - in addition to a decrease in one pupil, there is a retraction of the eyeball and ptosis of the upper eyelid (omission of the eyelid);

glaucoma - in addition to the narrowing of the pupil, there are severe headaches caused by increased;

the Argyle-Robinson phenomenon is a syphilitic lesion of the nervous system, in which photosensitivity decreases;

Parino's syndrome - in addition to the asymmetry of the pupils, there are multiple neurological symptoms associated with damage to the midbrain.

Symptoms

The symptom does not require special observation from adults. When one pupil exceeds the norm by more than 1 mm, this becomes noticeable even to a non-professional, and even more so it will not hide from the attentive gaze of a caring mother.

Anisocoria should always be examined by two specialists - an ophthalmologist and a neurologist.

It is not worth waiting until the eyes take on a normal appearance, that the difference will disappear by itself (as some parents believe, who are sure that children under 4 months have different pupils - in general, almost the norm). timely examination will eliminate unpleasant symptom and its reasons in full.

You should urgently go to the doctor if the child not only has pupils of different sizes, but also has a severe headache, bouts of nausea, if the asymmetry was preceded by a fall, hitting the head, other injuries, if the child begins to be afraid of bright light, his eyes are watery or he complains that he began to see worse and the image doubles.

Diagnostics

The task of the doctor is to find an unhealthy pupil, to determine which of the two pupils is suffering and which one is working normally. If the symptoms worsen in bright artificial light, doctors tend to believe that the cause lies in the damage to the oculomotor nerve. In this case, the patient's pupil is usually dilated.

If testing with light shows that the child feels worse when there is a lack of light or in the dark, then the reason is big share The probability lies in the defeat of the brain stem structures. At the same time, the pathologically altered pupil is narrowed and does not expand in the dark.

After inspection The child is scheduled for an MRI. This method allows you to confirm or refute the preliminary conclusions, as well as clarify the "problem" place.

Treatment

A well-known pediatrician, a favorite of many mothers of the world, Yevgeny Komarovsky warns parents against self-medication. Pupils of different sizes are a task for qualified doctors, no decoctions, lotions and miracle drops at home will help with anisocoria. If physiological anisocoria is diagnosed, you should not worry, it is enough to visit an ophthalmologist at the age of 3-4 years to check your eyesight. In most cases, pupillary asymmetry does not affect the child's visual acuity.

The method of treating anisocoria depends on the true cause of the phenomenon. With an ophthalmic injury, the eye doctor prescribes anti-inflammatory drops, antibiotics to eliminate the inflammatory post-traumatic syndrome. If the cause is a tumor in the brain, then it is prescribed drug treatment or surgical removal neoplasms.

If the true reason lies in the violation of the neurological plan, the treatment prescribed by the neurologist comes first - a complex of massage, medicines, physiotherapy.

The child is shown a reception nootropics that improve cerebral circulation, as well as after a traumatic brain injury.

Doctors' forecasts

The prognosis for anisocoria depends only on how quickly the real cause of the disease is identified, and on how quickly and effectively the child will receive the necessary treatment.

congenital pathology successfully treated with surgery. If the operation is not possible for a number of reasons, the child is prescribed drops in the eyes, which, if taken systematically, will maintain normal vision. With regard to acquired anisocoria, the prognosis is more favorable, while some congenital cases remain with the child for life and are not subject to correction.

For information on how the diagnosis is determined by the pupil, see the following video.

Anisocoria is a symptom in which the pupils of the right and left eyes differ in size. This condition is quite common in the practice of doctors and does not always mean the presence of any pathology in the body. It is believed that 20% of the population may have physiological anisocoria.

Normal pupil width in normal light should be 2-4 mm, and in the dark - 4-8 mm. The difference between them is no more than 0.4 mm. In bright light and in the dark, they respond with a uniform narrowing or expansion. Pupil size is regulated by the joint action of the muscles of the iris - m. sphincter pupillae (narrowing) and m. dilatator pupillae (expanding). Their work is coordinated by the autonomic nervous system: the parasympathetic one causes pupil constriction, and the sympathetic one causes its expansion.

By itself, the different size of the pupils rarely causes complaints. More often cause discomfort concomitant symptoms conditions causing anisocoria (for example, diplopia, photophobia, pain, ptosis, clouding, limitation of eyeball mobility, paresthesia, etc.).

Physiological anisocoria

It is not a pathology and is considered as a variant of the norm.

Characteristic manifestations:
. Anisocoria is more pronounced in the dark;
. reaction to light is preserved, correct;
. the usual difference in pupil size is up to 1 mm;
. when instilled with drops that dilate the pupil, the symptom disappears;
. with anisocoria of more than 1 mm and the presence of ptosis, a cocaine test (normal) helps in differential diagnosis.

Horner's syndrome

It is caused by a lesion of the sympathetic nervous system, accompanied, depending on the localization of the lesion, by ptosis, miosis, enophthalmos, slowing of pupillary reactions to light and impaired perspiration (anhidrosis).

Characteristic manifestations:
. In a lighted room, anisocoria is about 1 mm, but with a decrease in illumination, the difference between the pupils increases;
. when the lighting is turned off, the affected pupil expands more slowly than the healthy one;
. pathological cocaine test;
. for more accurate topical diagnosis, a tropicamide or phenylephrine test is used.

Paresis or paralysis of the oculomotor nerve

Violation of the parasympathetic innervation of the pupil as a result of damage to the third pair of cranial nerves usually has a compression etiology. In some cases, the condition may be diabetic and ischemic in nature, however, the pupil is rarely affected (about 33% of cases), and the degree of anisocoria is not very pronounced (up to 1 mm). Sometimes there is a restoration of nerve function in an aberrant way (aberrant regeneration): from the nerve fibers that innervate the oculomotor muscles, new ones begin to grow in the direction of m. sphincter pupillae. Thus, with certain movements of the eyeball, pupil constriction is noted.

Characteristic manifestations:
. The pupil on the affected side reacts worse to stimuli and expands in comparison with the healthy one;
. accompanied by ptosis and limitation of eye movement, isolated mydriasis without the above symptoms almost never occurs;
. the appearance of a “pupil of pseudo-Argyle Robinson” is possible: there is no narrowing of the pupil to light, but there is a reaction to the approach of an object;
. constriction of the pupil friendly to certain eye movements (synkinesia);
. the pupil on the damaged side is narrower in the dark and wider in bright light;
. often accompanied by an elevation of the upper eyelid in response to the deviation of the eyeball outward (pseudo-Grefe symptom);
. can simulate an acute attack of glaucoma, accompanied by severe pain, lack of reaction to light, however, unlike it, pain occurs not only in the eye, but also when it moves, there is no corneal edema.

Pharmacological reactions to drugs

Miosis (pupil constriction) can be caused by acetylcholine, carbachol, guanethidine and others. Mydriasis (pupil dilation) is caused by scopolamine, homatropine, adrenaline, naphazoline, xylometazoline, cocaine and other drugs. When using atropine, anisocoria is more pronounced than with other causes (usually about 8-9 mm). With systemic administration, the reaction will be bilateral.

Characteristic manifestations:
. Depending on the agent, both mydriasis and miosis can be observed;
. The dilated pupil does not respond to light pulses, the approach of objects under consideration, or the action of a 1% solution of pilocarpine;
. unlike traumatic damage to the iris, examination does not reveal other pathological changes(movements of the eyeballs, eyelids, fundus, functions of the trigeminal nerve are normal);
. as a result of the use of drugs with a mydriatic effect, near vision may be impaired, which improves with the use of plus lenses;
. drugs that cause miosis, on the contrary, provoke the development of accommodative spasm and deterioration of distance vision.

Mechanical damage to the muscular apparatus of the iris

It is the result of trauma, surgery (such as cataract removal), or inflammation (uveitis).

Characteristic manifestations:
. The slit-lamp examination is essential for establishing the diagnosis;
. the pupil of the affected eye is dilated, does not respond to light and instillation of medications.

intracranial hemorrhage

Anisocoria in this case occurs as a result of compression and displacement of the brain in the trunk area by a hematoma resulting from a traumatic brain injury, hemorrhagic stroke, etc.

Characteristic manifestations:
. a picture characteristic of the underlying disease;
. the pupil is dilated, usually on the side of the lesion, a more pronounced degree of dilation may indicate the severity of the hemorrhage;
. no response to light.

Acute attack of angle-closure glaucoma

Accompanied by mechanical dysfunction of the iris and deterioration of pupillary reactions.

Characteristic manifestations:
. Always accompanied by pain, corneal edema, increased IOP;
. the pupil is half dilated, does not react to light.

Transient anisocoria

May occur during a migraine headache, and also appear in conjunction with other signs of parasympathetic or sympathetic dysfunction that arose from other causes.

Characteristic manifestations:
. diagnosis is complicated due to the frequent absence of symptoms at the time of examination;
. with hyperactivity of sympathetic innervation, pupillary reactions to light are normal or slowed down, the palpebral fissure is wider on the side of the lesion, the amplitude of accommodation is normal or minimally reduced;
. with paresis of parasympathetic innervation, pupillary reactions are absent or significantly depressed, the palpebral fissure in the involved eye is smaller, and the amplitude of accommodation is markedly reduced.

Conditions manifested by the "light-near" dissociation syndrome, in which there is no reaction of the pupil to a light stimulus, but there is a reaction to the approach of the object in question.

Parino syndrome

Occurs when the dorsal (posterior) parts of the midbrain are affected. It can be caused by trauma, compression and ischemic lesion, tumor of the pineal gland, multiple sclerosis.

Characteristic manifestations:
. Perhaps the appearance of the pupil "pseudo-Argyle-Robinson": there is no narrowing of the pupil to light, but there is a reaction to the approach of the object;
. paralysis of the gaze upward;
. convergence-retraction nystagmus: when you try to look up, the eyes are reduced inwards, and the eyeball is retracted into the orbit;
. elevation of the upper eyelids (Collier's symptom);
. pilocarpine test is normal;
. sometimes accompanied by optic disc edema.

Argyle Robertson's pupil

A condition caused by damage to the nervous system by syphilis.

Characteristic manifestations:
. The lesion is bilateral, characterized by a small size of the pupils, the absence of their reaction to light and its preservation when viewing closely spaced objects;
. little or no effect on the effects of mydriatics;
. pilocarpine test was normal.

Tonic Pupil Edie

It develops with a unilateral violation of parasympathetic innervation due to damage to the ciliary ganglion or short branches of the ciliary nerve. It is more common in women 30-40 years old. The cause is a viral or bacterial infection affecting the neurons of the ciliary ganglion as well as the dorsal root ganglia.

Characteristic manifestations:
. The dilated pupil can return to its previous state for a long time;
. abnormal pupil shape associated with segmental paralysis m. sphincter pupillae;
. worm-like radially directed movements of the pupillary edge of the iris;
. slow pupillary constriction in the light;
. after narrowing the same slow expansion;
. disturbance of accommodation;
. the pupil responds better when focusing on near objects than on light, but the reaction may be slower;
. may be associated with loss of Achilles and knee reflexes (Edie-Holmes syndrome) and segmental anhidrosis (Ross syndrome);
. expands well when using mydriatics;
. pathological pilocarpine test

Diagnosis of anisocoria

The beginning of the diagnostic search lies in a thorough history taking. It is important to find out the presence of concomitant pathology, the duration of manifestations and the dynamics of their development. Old photographs of the patient often help in the diagnosis - they can determine whether this symptom was present earlier or arose later.

Such key points examinations, such as determining the size of the pupils in the light, in the dark, their reaction and its speed, symmetry in various lighting conditions, help determine the cause and its approximate anatomical localization. With anisocoria, more pronounced in the dark, a smaller pupil is pathological (the ability to expand is weakened). With anisocoria, more pronounced in bright light, a larger pupil is pathological (its narrowing is difficult).

Additional manifestations, such as pain, double vision (diplopia), ptosis, help in the differential diagnosis. Diplopia and ptosis in combination with anisocoria may indicate damage to the third pair (oculomotor) cranial nerves. Pain often indicates an expansion or rupture of an intracranial aneurysm leading to compression paralysis of the third pair of cranial nerves, or a dissecting aneurysm of the carotid artery, but is also characteristic of microvascular oculomotor neuropathies. Proptosis (protrusion of the eyeball anteriorly) is often the result of volume lesions of the orbit.

Of the additional examinations, an MRI or CT scan is most often needed. If vascular anomalies are suspected, contrast angiography and Doppler ultrasound will be indicative.

Pharmacological tests

cocaine test. The 5% cocaine solution test (2.5% solution is used in children) is used to differentiate between physiological anisocoria and Horner's syndrome. Pupil sizes are estimated before and 1 hour after instillation of drops. In the absence of pathology, they expand evenly (anisocoria up to 1 mm is acceptable), while in the presence of Horner's syndrome, the maximum expansion of the pupil on the affected side does not exceed 1.5 mm. As a replacement for cocaine, a 0.5-1.0% solution of apraclonidine can be used.

Tropicamide and phenylephrine tests. 1% solutions of tropicamide or phenylephrine are used to establish damage to the third neuron of the sympathetic system, while they do not exclude its violation at the level of neurons of the first and second orders. The technique is similar to the cocaine test, but pupils are measured 45 minutes after instillation. Pathological reaction is an expansion of less than 0.5 mm. If, after instillation, anisocoria increased by more than 1.2 mm, then the probability of damage is about 90%.

Pilocarpine test. The affected pupil is sensitive to a weak 0.125-0.0625% solution of pilocarpine, which does not affect a healthy pupil. The result is evaluated 30 minutes after instillation.

Treatment of anisocoria

Since anisocoria is only a symptom, treatment directly depends on the cause that caused it. So, physiological anisocoria does not require any therapy, since it does not have a pathological process in its basis. However, if it is a consequence of any pathological process in the body, the prognosis of recovery can be directly related to the earliest possible start of treatment. If necessary, it is carried out in conjunction with a neurologist or neurosurgeon.