Treatment
Medical Care
Medical care depends upon the underlying pathophysiology.
If the patient has associated accommodation paresis, reading glasses or bifocals may be required.
If the patient has mydriasis and glare, dilute pilocarpine, sunglasses, or FL-41 lenses may be beneficial.
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Surgical Care
Surgical care depends upon the specific etiology.
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Consultations
Consultations depend upon the underlying cause. Compressive third nerve palsies and aneurysms may require neurosurgical intervention, whereas ophthalmologists may be helpful in other causes of anisocoria.
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Further Inpatient Care
Follow-up, treatment, prognosis, and educational issues depend upon the underlying diagnosis.
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Media Gallery
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Flowchart to assist in the diagnosis of anisocoria (modified with permission from Thompson and Pilley)
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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.
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Horner syndrome due to carotid dissection. Note the increase in degree of anisocoria under dark conditions.
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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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