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Anisocoria Follow-up

  • Author: Eric R Eggenberger, MS, DO, FAAN; Chief Editor: Edsel Ing, MD, FRCSC  more...
 
Updated: Jun 16, 2016
 

Further Inpatient Care

Follow-up, treatment, prognosis, and educational issues depend upon the underlying diagnosis.

 
Contributor Information and Disclosures
Author

Eric R Eggenberger, MS, DO, FAAN Professor, Vice-Chairman, Department of Neurology and Ophthalmology, Colleges of Osteopathic Medicine and Human Medicine, Michigan State University; Director of Michigan State University Ocular Motility Laboratory; Director of National Multiple Sclerosis Society Clinic, Michigan State University College of Human Medicine

Eric R Eggenberger, MS, DO, FAAN is a member of the following medical societies: American Academy of Neurology, American Academy of Ophthalmology, American Osteopathic Association, North American Neuro-Ophthalmology Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Biogen; Genzyme; Novartis; Teva <br/>Received research grant from: Biogen; Genzyme; Novartis<br/>Received consulting fee from Biogen for consulting; Received consulting fee from Teva for consulting; Received consulting fee from Acorda for consulting; Received grant/research funds from Novartis for independent contractor; Received honoraria from Genentech for speaking and teaching; Received honoraria from Genzyme for speaking and teaching.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jane W Chan, MD Professor of Neurology/Neuro-ophthalmology, Department of Medicine, Division of Neurology, University of Nevada School of Medicine

Jane W Chan, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Ophthalmology, American Medical Association, North American Neuro-Ophthalmology Society, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, Canadian Society of Oculoplastic Surgery, European Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Ontario Medical Association, Statistical Society of Canada, Chinese Canadian Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

James Goodwin, MD Associate Professor, Departments of Neurology and Ophthalmology, University of Illinois College of Medicine; Director, Neuro-Ophthalmology Service, University of Illinois Eye and Ear Infirmary

James Goodwin, MD is a member of the following medical societies: American Academy of Neurology, Illinois State Medical Society, North American Neuro-Ophthalmology Society, Royal Society of Medicine

Disclosure: Nothing to disclose.

References
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  3. Thompson S, Pilley SF. Unequal pupils. A flow chart for sorting out the anisocorias. Surv Ophthalmol. 1976 Jul-Aug. 21(1):45-8. [Medline].

  4. Freedman KA, Brown SM. Topical apraclonidine in the diagnosis of suspected Horner syndrome. J Neuroophthalmol. 2005 Jun. 25(2):83-5. [Medline].

  5. Martin TJ. Horner's syndrome, Pseudo-Horner's syndrome, and simple anisocoria. Curr Neurol Neurosci Rep. 2007 Sep. 7(5):397-406. [Medline].

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  7. Wehbe E, Antoun SA, Moussa J, Nassif I. Transient anisocoria caused by aerosolized ipratropium bromide exposure from an ill-fitting face mask. J Neuroophthalmol. 2008 Sep. 28(3):236-7. [Medline].

  8. Andreola B, Piovan A, Da Dalt L, Filippini R, Cappelletti E. Unilateral mydriasis due to Angel's trumpet. Clin Toxicol (Phila). 2008 Apr. 46(4):329-31. [Medline].

  9. Cremer SA, Thompson HS, Digre KB, Kardon RH. Hydroxyamphetamine mydriasis in Horner's syndrome. Am J Ophthalmol. 1990 Jul 15. 110(1):71-6. [Medline].

  10. Harle DE, Wolffsohn JS, Evans BJ. The pupillary light reflex in migraine. Ophthalmic Physiol Opt. 2005 May. 25(3):240-5. [Medline].

  11. Kardon RH, Denison CE, Brown CK, Thompson HS. Critical evaluation of the cocaine test in the diagnosis of Horner's syndrome. Arch Ophthalmol. 1990 Mar. 108(3):384-7. [Medline].

  12. Lowenfeld IE. The Pupil. Anatomy, Physiology, and Clinical Application. 1993.

  13. Miller NR, Newman NJ, eds. Walsh & Hoyt's Clinical Neuro-ophthalmology. 1998. Vol 1:

  14. Moster ML, Galiani D, Garfinkle W. False negative hydroxyamphetamine test in horner syndrome caused by acute internal carotid artery dissection. J Neuroophthalmol. 2003 Mar. 23(1):22-3. [Medline].

  15. Pishdad GR, Pishdad P, Pishdad R. Pupillary autonomic neuropathy simulating partial Horner syndrome in diabetes mellitus and its reversal with control of blood glucose. J Neuroophthalmol. 2008 Sep. 28(3):241-2. [Medline].

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Flowchart to assist in the diagnosis of anisocoria (modified with permission from Thompson and Pilley)
Horner syndrome secondary to carotid dissection. Note that degree of anisocoria is relatively mild in room light. Also, see the image below of the same patient.
Horner syndrome due to carotid dissection. Note the increase in degree of anisocoria under dark conditions.
Typical pupil in third nerve palsy, with mydriasis. Note the inability to adduct the right eye. This patient has a skull-based meningioma that is compressing the right third nerve. At rest, complete ptosis is present in the right eye; however, lid elevation with attempted adduction of the right eye is noted, which is consistent with aberrant regeneration.
 
 
 
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