Anisocoria!! !

I'm a 23 year old male. I first noticed having unequal pupil size in march of 2010. I was very anxious at the time due to a new job and instantly started googling and thought I had a brain tumor or anyuersm. I would feel dizzy have sharp head pains numbness in face and more. The right pupil is always the larger and the right is always the smaller one. Sometimes they are dramatically uneven sometimes they are completely even, if I'm anxious or have a headache it doesn't matter, it still seems to either be even or uneven at random times no matter what. I also suffered from extreme brain fog and these bouts of internal tremor which have stopped except for sometimes. Between march 2010 and now I've had the following tests done: Mri of the head, mri of the head with contrast. Mra of the head and neck. Sleeping EEG. Ultrasound of arteries in neck. I've also had a full cardio workup because of palpitations. Everything came back normal except an echo showing an EF of 50% which has now gone to normal ranges 60-65%. And an mri showed a 3.. Pineal cyst I was told is begnign. I have blurred/double vision in the right eye( larger pupil) even when they are even. Opthamologist did full exam with dialation and eye pressure test all came back fine. The blurred vision is corrected by pinholes. Why are the pupils usually uneven and sometimes not? Is there still a chance of a serious problem that was missed?

[Houman Vosoghi, MD]

Yes.  There are multiple potential causes of anisocoria.  It needs to be evaluated with a sequence of very specific tests to determine if it is anything of concern or not.  Go see a neuro-ophthalmologist who can perform the appropriate sequence of tests that require different drops to be administered in different concentrations on different days.

HV