Pupilarry Defect-Loss of Vision and Pupil Shape Oval Slanted?

[Aneliese]

  Hi CCF, My neurologist in February noticed I had a irregular pupil defect. My pupil in my left eye takes on a oval shape slatted to one side. Sort of like a cat's eye. I also experience loss of vision. I am still in progress for last three years for diagnoses of possible MS, SLE and Chiari Malformation type 1.  This pupil defect could it becaused by neurological disease or is it usually related vision defect?
  I have noticed my pupil doesn't change back to normal. With permanent loss of vision in left eye, shoud I seek out examination by Ophthamologist?
  Thanks Sincerely, Anneliese
  Ps. Sorry to be such a pest here asking so many questions.  I hoping in the new year with switching HMO group that I can start over with new neurologist and also see a neurosurgeon specializing in Arnold-Chiari Malformations.
  Thanks again for all your help. I really wish my doctors would reffer me to your clinic. I realize my problems are difficult to solve by the specialists I have seen up to now.
  I just wish there was a medical center of your excellance here in CA.
Dear Anneliese:
Sorry to hear about your vision loss.  I guess the first question is whether you might have always had an abnormal pupil.  If you have an old photograph of yourself you might be able to tell.  The question, is whether the change in pupil shape was congenital and only noticed by the neurologist or whether it had anything to do with your vision loss.  Chiari I malformation is likely not the cause of your pupil change.  Certainly, MS can change your vision as you have experienced but this would have been picked up on MRI.  A CNS vasculitis could also cause blindness, but usually not a ovid pupil shape.  Has your vision returned at all, and have your physicians explained the etiology of your vision loss?  I have seen pupils that are ovoid in patients with congenital syndromes and as a normal variant.  Usually, the changes in pupil shapes are either big or small but round.  Does the pupil react to light?  Does it change size in the dark?  Are you taking any medications?  If you haven't gotten a good reason for
your vision loss than by all means see a opthalmologist.  There are plenty of good neurologists on the west coast, UCLA, Stanford, UCSF etc.  I would get a good neurology visit and have them go over you completely.  Best of luck.
Sincerely,
CCF Neuro[P] MD