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Pupils of Different Sizes
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Pupils of Different Sizes


My son is 4 years old.  About a week ago we noticed that his pupils are 2 different sizes (measurement showed 1mm difference).  It is only obvious in dim light or dark.  In bright light they constrict to very small.  He has no eyelid droop, lack of sweating, etc. indicating Horners Syndrome.  The Ophthlamologist dilated his eyes at 10AM on Friday.  The pupil that is usually smaller came out of dilation in about 5 hours but the other pupil still seems dilated (slightly) 30 hours later.  His eyes are very light blue.  Is it normal for pupils to become undilated at different speeds after an eye exam?  My husband was holding him when the put the drops in and said that the drops went into the eye better of the one that is still dilated.  Could the fact that the smaller one came out of dilation so quickly be an indicator of what the problem could be.  The Ophthlamologist says kids can get things in their eyes all the time that cause dilation of one eye and thus unequal pupil size.  She said she wants to give it another week and see if goes away on its own but we have an appt. for next Friday if it does not resolve.  I am worried and do not want to wait to get some answers about why his pupils are coming out of dilation differently.

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many patients have unequal pupils so that by itself is nothing to be concerned about.  There are some reasons why the dilation is wearing off differently.  It is possible a longer acting drop was put in one eye than the other or more drops put in one eye than the other.  I think waiting a few more days as your ophthalmologist suggested is reasonable and most likely your sons pupils will return to their normal baseline, with one larger than the other.
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