Anisocoria for three months

How can an eye doctor know that it's physiologial anisocoria without using cocaine drops or any other drops.  Isn't that the way to differentiate between horners and physiological?  I have had anisocoria for three months and I'm scared it's going to manifest in a ruptured aneurysm, brain tumor, or some other bad disease.  My anisocoria is worse in the dark and sometimes it changes sides, based on the time of day.  Any information anyone has would surely be appreciated.  Also, my eye hurts in the back when I move it....(the big pupil eye)

[Joan M Pernoud, MD]

Physiological anisocoria is usually defined as a pupil difference of not more than 1 millimeter. Also, it usually does not change significantly through life.

A more acute pupillary anisocoria is from Adie's tonic pupil which often occurs in early adult life often at some time following a viral disease or for no known reason. The pupil moves very slowly and examination of the pupil with the slit lamp at the ophthalmologist's office is usually diagnostic as the iris tissue moves in a characteristic way. This would explain why sometimes one pupil is bigger and sometimes smaller. This is a benign condition.

An eye MD ophthalmologist should take a look and will be able to decide which kind of pupil abnormality you have. Check aao.org to locate a doctor. This is a medical condition so any medical insurance should cover this.

[munthek]

Thank you for your response.  I did see an eye doctor and he said it was "physiological" and about one mm... Although, I think it is way bigger than one mm sometimes.  I haven't had this my whole life, just the last three months.  I think I've been spending too much time on the internet, because I've been looking at the algorithms and it says to use cocaine drops to differentiate between horners and simple anisocoria.  Not that I want cocaine in my eye or anything........I just want to live a little longer.  Can the doc tell that it's physiological just by looking at it?

[Joan M Pernoud, MD]

If you saw an eye MD ophthalmologist, I presume the diagnosis is correct. Adie's pupils can be subtle but are still benign.

A Horner's syndrome includes eyelid droopiness and a smaller pupil on that side.

Cocaine eyedrops are essentially non-existent anymore but there are other tests for some of the other more significant pupil abnormalities.

Remember too that most serious neurological conditions have other signs or symptoms because the brain is a small area and other functions are also involved.

If you want to take the next step, I would see a neuro-ophthalmologist usually found at a teaching university hospital.

[munthek]

Thank You, Dr. Pernoud.

Your last post made me feel a little better.  I think I will monitor this and if I have any changes I will seek further help.  Are there varying degrees of an Adie's Pupil?    Could the ansocoria become even greater with time?

[Derekmassie]

I have had mutiple ct scans and also went to the eye doc about anisocoria. This continues to worry me because it started one year ago after a closed head injury. I'm running out of questions to ask my provider please help me figure this out.  Also the ct scans came back negative both times and when they dilated my pupils it came back negative this is also more then 2mm difference in my eyes in the morning and become even during the day please help.