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Pupillary Abnormalities


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When there is a problem with your pupils – the black part at the center of your eyeball – you have what’s known as a pupillary abnormality. The main types of pupillary abnormalities include:

  • Anisocoria: unequal pupil sizes
  • Horner’s syndrome: disruption of a nerve pathway from the brain to the one side of the face and that eye
  • Third nerve palsy: one eyelid is completely closed, and that eye has moved outward and downward
  • Adie’s tonic pupil: one pupil is permanently dilated and unresponsive to light and other stimulants

Symptoms of a pupillary abnormality include:

  • Decreased or increased size of one pupil
  • Difficulty focusing on objects in near visual field
  • Diplopia (double vision)
  • Drooping eyelids (ptosis)
  • Headache
  • Light sensitivity
  • Problems moving your eye


Comprehensive Exam -

Your doctor will conduct a thorough physical examination of your eyes – as well as gather a complete health history – to determine if you have a pupillary abnormality. This may include using eye drops to dilate your pupils to see how each react to the dilation process.

Imaging - If your specialist suspects you may have Horner’s syndrome, they may order magnetic resonance imaging (MRI) or a computerized tomography (CT) scan to locate the site of the abnormality that is causing the condition



None Required - There is no treatment required for physiologic anisocoria.

Treatment of underlying cause - If Horner syndrome or third nerve palsy is related to an underlying cause, treatment is needed.

Eye Patch - If you have third nerve palsy, wearing an eye patch over the affected eye may help reduce double vision (diplopia).

Prism Eyeglasses - Wearing eyeglasses affixed with a prism may help relieve your diplopia.

Sunglasses - If your pupillary abnormality has caused your eyes to be unusually sensitive to light, you should wear protective sunglasses whenever outdoors in sunlight.

Eye Drops - If you have Adie’s tonic pupil, your eye care specialist may prescribe Pilocarpine eye drops to constrict the affected pupil.

Surgery - If you have third nerve palsy is related to an aneurysm or mass, you may need neurosurgery. If you have third nerve palsy that has not resolved after a waiting period of six months and is stable, your doctor may recommend you undergo surgery to realign your eyes or to correct drooping of the eyelid.

Why Choose Bascom Palmer Eye Institute?

Ranked #1 by U.S. News & World Report. Bascom Palmer Eye Institute, part of the University of Miami Health System, is the top-rated facility in the country for the treatment of diseases and disorders of the eye. When you choose us for your eye care, you will receive the best care in the nation in a compassionate setting.

Patient-friendly care. We take the time to understand your eyes. Our team coordinates your vision care, guides you along your journey to improved vision and connects you to valuable patient resources.

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