Anisocoria

[ak82]

Hi there,

For about 2 months now, i have noticed that my left eye tends to be 1mm smaller than my right.  Sometimes they are the same size, sometimes it seems that the difference could be closer to 1.5mm.  (in darkness)

I went to see an eye doctor at moorfields eye hospital in london and explained my situation.  I was having eye musculator pain, and sometimes focal.  No vision impairment at all.  My eyes would stream heavily in air conditioning environment and in hot countries.

He noted that my left eye was very dry.  Suspected in the right too, but much more in left.  He prescribed me several eye lubricants.  Celluvisc eye drops, Viscotears gel, and Lacri-lube for night time use.

I voiced my concerns over Horners as i have had a hard palate swelling recently.  I have had an MRi for it which showed, thickened left ethmoid sinus, left maxillary antrum mucus retention cyst, and slightly larger left tonsil.  This had me worried that possibly the swelling was affecting the eye.

Since using the eye medication (4 days ago) the pain seems to have gone almost completely.  What does worry me, is that approximately an hour or two after using the eye drops, or Viscotears, the anisocoria seems to switch sides.  I have read the Iopidine eye drops cause this switching affect, and is a way of diagnosing Horner's.

The ingredients in the eye drops are:  Carmellose sodium 1.0% (w/v), Sodium chloride, Sodium lactate, Potassium chloride, Calcium chloride and Purified water.

Viscotears:  Carbomer 2.0mg/g (0.2%), Cetrimide, Sorbitol, Sodium Hydroxide and Water.

Continued....

[John C Hagan III, MD, FACS, FAAO]

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[ak82]

thank you very much for your time.  much appreciated.  good day to you.

[John C Hagan III, MD, FACS, FAAO]

I would like to give your reassurance but I can't do it catagorically.  Monitor the condition and if it gets worse or something new develops go back for a re-exam.

JCH MD

[ak82]

Also, the celluvisc eye drops he gave me, do come in lots of small individual packets.  He told me that the drops he prescribed me have no 'drugs' in them (i think thats how he described them) but definately said i can use them as much as i want and its not possible to overdose on them.

Should that mean that whatever effects i was seeing from the use of the drops is purely coincedental?

Thanks

[ak82]

Thanks for your reply.

I heard that miosis could be caused by inflammation, and i read that dry eyes can cause inflammation.  I was just doing 1 + 1 kind of thing.  The optician actually told me, i 'catagorically' do not have horner syndrome, and i think actually got a little annoyed with me because i seemed so concerend about it and kept asking him if he was sure or not.

If artificial tears should not affect pupil size, then it may just be coincidental.  Or my pupil may be getting larger in that eye because its lubricated for once.

On inspection with a ruler, the pupil difference is only ever 1mm difference at its greatest.  It just looked like more to me.

My fingers crossed that this is just physiological.

Thanks again for your reply

[John C Hagan III, MD, FACS, FAAO]

Dry eyes even severe dry eyes causing structural damage to the cornea should NOT cause miosis.

It seems your pain was due to dry eyes.  

It is very unusual for artifical tear drops to affect the pupil size. The same is not true of whitening drops like Visine or Murine or any drop for "allergy".

You might try a preservative free artifical tear (they come in small individual dropperette) and see if that has the same effect.

You might discuss your concerns to the specialist at Moorfield (a very fine hospital indeed) and ask for a referral to a neuro-ophthalmologist.

JCH MD

[ak82]

I was wondering if any of these ingredients should affect pupil miosis?  Is the switching coincidental?  Do i just have transient anisocoria?


The eye doctor said i do not have Horner's but i was wondering if that is because i dont have ptosis and the asymmetric sweating.  Could it be an early sign, and these affects would appear later?  From looking at pictures of when i was younger, i did not have anisocoria.

The anisocoria does not seem to have changed at all since using the eye drops, apart from as i say an hour or two after use, they switch sides, and then back again an hour or so later.

My hope is that the extreme dryness in the left eye has caused the miosis, and after the month of precribed treatment it will return to normal, but i am not sure.  I would have thought after using the drops, the pupils would be the same size.  Not reversed.  If anyone knows the affects of the ingredients posted, it would help.

Any help would be very appreciated.

Thank you very much for reading.