Uneven pupils in the morning (always resolves)

[mhsdrum]

Hello,

I am trying to get to the bottom of an ongoing issue I am encountering each morning.  When I first wake up each morning, my left pupil is almost always slightly larger than the right (approximately 10-15% larger).  It seems to dilate and and shrink when exposed to/removed from a light source, however it does not seem to constrict as efficiently as the right when I use a flashlight in a dark room (but it does still constrict a little).

Peculiarly enough, the issue seems to resolve itself within a couple hours of being awake and moving around/walking etc, and the pupils respond equally and normally from what I can observe.  On rare occasions, the larger pupil will return in either eye in the afternoon, but it is rare and never lasts long.

I saw a neuro-opthomalogist and a neuro-otologist/ENT and radiologist.  Opth Dr said I was fine (no signs of retinal detach and will see me again in a month), and the oto-ENT said I have hyper nervous system tendencies which are migraine in nature. He suspects I have a migrainal (a non-headache type) condition which has caused some dizziness (more of a detached, spacey feeling).  Only other thing to note is that I had sudden onset of many dark and light floaters 2 months ago which prompted the opth visit.

I am on some anxiety and anti-depressant meds (Buspirone, Imipramine, and Clonazepam).

I was unable to reproduce the unequal pupils in the opth's office exam (of course, right?)  :)

Does this at all sound like something normal or should I be concerned of something like Marcus Gunn Pupil (Afferent Pupillary Defect)?  Any information you can tell me would be of much help!

[mhsdrum]

Thanks Dr. O!

I am hoping for no changes detected at my follow up exam.

[Ray T Oyakawa, MD]

I have nothing to add.  You have been worked up completely.  A Macus Gunn Pupil--both are the same size.  They just reactive differently,.

Dr. O.