What is Physiologic anisocoria?

Physiologic anisocoria:

Anisocoria meaning/deffinition:
Unequal size of the pupil is known as anisocoria.
✍️ physiological anisocoria also called benign, essential, or simple anisocoria

✍️ common up to 20%

✍️ difference 0.4–1 mm between 2 eyes

✍️  same difference in dim and bright light but it can be slightly more prominent in darkness

✍️ not influenced by

☝️sex

☝️age

☝️iris color.

✍️ importance of Physiologic anisocoria

☝️ whenever diagnosed  , we can avoid inappropriate  unnecessary diagnostic testing and further investigations and patient can be reassured.

☝️ physiologic anisocoria  could occur in combination with levator dehiscence on the side of the smaller pupil, mimicking Horner’s syndrome (pseudo-Horner’s syndrome)  with 0.5% apraclonidine test we could exclude a true Horner’s syndrome

Differential Diagnosis of  Anisocoria: ( unequal pupil size ) 👩‍🏫👸

  ✍️ Anisocoria greater in darkness( can’t dilate )

☝️Horner’s syndrome

☝️Iris adhesions (posterior synechiae)

☝️Pharmacologic (pilocarpine)

☝️Physiologic anisocoria

✍️ Anisocoria greater in bright light( can’t constrict)

☝️ Third nerve palsy

☝️ Tonic pupil

☝️Iris trauma

☝️ischemia

☝️Pharmacologic (mydriatics)

☝️ adhesions and synechia

☝️aniridia

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