Abnormal small pupil

[fedor647]

I am 36 year old caucasian male, near sighted. Around 6/09 I noticed that my eye pupils vary in size with no other symptoms.  Earlier that year, 2/09,  I was diagnosed with partial vitreous detachment in both eyes but from what I understand it is not relevant and my doctor did not comment on my pupil size so I do not think it was present at the moment ( I was examined before being dilated).

I went to see my general ophthalmologist around 10/09 for pupil size difference and after examining me with slit lamp in bright and dim light, doctor diagnosed that my RIGHT smaller pupil is the abnormal one. I have no eye lid drooping but to rule out Horner's doctor did an eye drop test. I don't remember the name of it, it was not a cocain drop but rather some drops that are used for glaucoma treatment. After one hour the pupil difference was still the same so doctor said that means my pupil size difference is physiological.

To add to my eye history, I was diagnosed with floppy eye lid syndrome and due to my eye pressure being high 20(left)/26(right) we did some follow up tests and found some peripheral vision loss so I was also diagnosed with open angle glaucoma and I am trying Travatan in my right eye now.

I would like to get your opinion if I should see a  neuro opthamologist to further investigate whats wrong with the pupil and/or get second opinion. Also, what physiological causes are there for abnormal smaller pupil and could open angle glaucoma / eye pressure cause it? I would love to hear your thoughts doctors.

Thank you.

[Sandra M Brown, MD]

You were tested for Horner Syndrome with brimonidine which is a highly effective test.  If it was negative, you do not have Horner Syndrome.  With no other abnormalities I would agree with the diagnosis of physiologic anisocoria.  I don't see any benefit to a neuro-ophthalmology evaluation at this point.

A separate concerning issue is why a young person has unilateral glaucoma and already has peripheral vision loss.  One possibility that comes to mind is a condition called pigment dispersion syndrome. You do need to ask your doctor WHY he thinks you already have glaucoma.  Nearsightedness is not a risk factor for open angle glaucoma, and travatan does not affect pupil size. Ask around in your family (even cousins) for a history of early-onset glaucoma.

[fedor647]

Thank you for your response Dr. Brown. This is very helpful and I will talk to my doctor regarding possible reasons for my glaucoma and pigment dispersion syndrome. I will post back when I know more.