PUPIL SIZE

The pupil in my left eye is significantly bigger than my right eye and does not react to light.  I had an eye exam from a doctor at the local mall the other day.  He wants me to come back to see him in two weeks for a follow up appointment to see if my left pupil has changed in any way.  From the eye exam he gave me, he said my optic nerves were healthy and my cornea was in good shape.  I get little twitches of pain that come and go in my left eye socket but he says it probably has nothing to do with the pupil not reacting.  My question is...if my eye appears to be in good shape, then what could be causing my pupil to not react to light?  Should I be concerned?

[Michael J Kutryb, MD]

I suggest you see an ophthalmologist, preferably a neuro-ophthalmologist for evaluation of anisocoria (uneven pupils.)  Possible causes include previous trauma, horner's syndrome, adie's tonic pupil, third nerve palsy, or even a side effect of certain eyedrops.  It is important to determine which pupil is abnormal, the larger or smaller.  You seem to think it is the larger one because it doesn't react normally.  Be on the lookout for any droopiness of the eyelids or double vision which are particularly bad signs.  Anisocoria can be a complex problem to diagnose properly and I again strongly suggest you see an ophthalmologist.

Michael Kutryb, MD
Kutryb Eye Institute
www.kutrybeye.com