Horner's syndrome?

[joannela]

Hello:

I have uneven pupils and am concerned about something serious. The left is slightly larger in normal light, and quite a bit larger in dim light - I believe more than 1mm.

I was first made aware of this difference in pupil size 10 years ago by a neurologist I visited for dizziness. At the time I had an MRI with and without contrast, MRA, EEG - all normal.  Since then I've had at least one chest x-ray (about 6 years ago) for a cracked rib and it was normal.  I have no ptosis, pain, or loss of sensation or lack of sweating on that side of my face. I never thought much of it untiI recently had a VNG and with the lights dimmed the audiologist said it almost looked like two different persons' eyes.  I have no idea if the difference was that much 10 years ago or if it's gotten worse.

Since I've the uneven pupils for at least 10 years, should I still be concerned?

Is it possible that if it's gotten worse that it could be Horner's even without the associated ptosis, etc?

I had a dilated eye exam in December and nothing was noted, however my eyes were dilated before the opthamologist saw me. The tech noticed the pupils and put it in my chart, but the doctor didn't say anything about it.

I am scheduled for an MRI tomorrow (for other reasons).

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

You're welcome
JCH III MD

[joannela]

Yes sir, I knew the abnormal one is the smaller one.  The difference is noticeable and since there is the oft-mentioned "dilation lag" in my smaller one, so I was quite worried. No ptosis though so hopefully it's just physiological.

Thanks very much for your answer.
Joanne

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

About 10% of people have small differences in the size of their pupils as a normal variant. I would not be concerned in your case unless something else develops. Ptosis is by definition part of Horner's Syndrome so if you don't have it you don't have Horn'ers and as you may know on Horner's the SMALLER pupil is the abnormal one.

Next check up ask the Eye MD to look at the pupils before the drops are put in (tell the techs).

JCH III MD

[joannela]

Sorry - there is no text here. is there a response?

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

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[joannela]

More follow up:

I recently saw a neuro for dizziness.  He noted the pupils but when I told him it was noted 10 years ago he said 'probably just the way you're built then.'  He didn't mention any ptosis, etc.  (It was after this at the VNG that I got nervous about the audiologist's comment).

Also, both pupils are reactive to light.

[joannela]

Follow up -

My mother says she has uneven pupils as well - I have no idea to what degree, though. I've never noticed.