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Left pupil large and irregularly shaped
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Left pupil large and irregularly shaped

Yesterday morning I had a strange feeling in my left eye and my vision was a bit fuzzy, and when I went and looked in the mirror my left pupil was much larger than the right and was not round... I went and lied down for a few minutes and when I looked again it was back to normal. It does not hurt, just feels odd, hard to focus and a slight headache/nauseous feeling. I have never had this happen before, and it is very creepy. It happened again last night and again this morning.

It almost feels as though there is a tiny muscle spasm in the eyeball, which is causing the pupil to be pulled a bit to the side, causing it to be larger and not round. I have no idea whether this is even possible... advice would be very much appreciated!
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Avatar_dr_m_tn
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

I would suggest that you be seen by an ophthalmologist (an eye specialist). From the neurological perspective, abnormal pupil sizes can be caused by lesions to the third nerve – as may be the case by an aneurysm compressing the nerve. This would cause an enlarged pupil. Another cause of abnormal pupil size can be related to injury to the neck causing injury to the nerve fibers near the carotid artery. This injury may occur with a motor vehicle accident. This causes a smaller pupil.

The intermittent nature of your pupillary changes would make the above considerations less likely. There is a condition called episodic anisocoria that may be related to the intermittent spasm of the pupillary dilator muscle. Another benign condition is called hippus which is the constriction-relaxation of the pupillary muscles particularly with light.

Do you have headaches with your pupillary changes? There are headaches called cluster headaches that can cause changes in pupil size.

Again, I would suggest that you follow up with an ophthalmologist. He/she would be best at determining the cause of your pupil size changes.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
2 Comments
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Avatar_n_tn
Thank you so much for that information. I did end up going to the hospital Sunday to have it checked, and saw an ophthalmologist who did a thorough exam and said that my eyes both look very healthy and couldn't see any cause for the strange pupillary changes, and also ruled out Horner's syndrome. Unfortunately it wasn't happening when I was there...

With your idea of 'episodic anisocoria' I was able to google that and found some very useful information and read about 'tadpole pupil'. I found this case study report which sounds exactly like what I have been experiencing. It sounds like my idea of a tiny muscle spasm was pretty much on track, and it was really nice to hear that I am not alone!...

The article is at  http://www.nature.com/eye/journal/v18/n1/full/6700513a.html

Thank you again for your input!

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