PUPILLARY ABNORMALITIES: Anisocoria Pupillary Abnormality Equal (Isocoria) Unequal (Anisocoria) Pathological Physiological Anisocoria equal in light and dark, 10% cocaine: pupils dilate symmetrically Fixed PupilImpaired Constriction Parasympathetic dysfunction Anisocoria greater in light Large pupil abnormal Impaired Dilation Sympathetic dysfunction/Horner's Syndrome: miosis, anyhydrosis, ptosis Anisocoria greater in dark Small pupil abnormality Preganglionic Ptosis, opthalmoplegia Constriction with 0.1% pilocarpine Postganglionic Constriction with 0.1% pilocarpine Neuromuscular Junction No constriction with 0.1% pilocarpine Preganglionic No dilation with 0.125% adrenaline Postganglionic Dilation with 0.125% adrenaline Angle Closure Glaucoma (mid-fixed) Iritis/Synechiae (not complete fixation) Trauma (not complete fixation) Oculomotor Nerve/Fascicle (Other CN III Findings) Tonic (Adie's) Pupil (Ciliary Ganglion Lesion) Pharmacologic Factitious Idiopathic Trauma Tumor (Lung, Breast, Thyroid) Cluster Headache Carotid Dissection Trauma Idiopathic Simple Anisocoria ( <0.5mm)Clinical Pearl:Pupils should be examined in both a light and dark setting to determine whether the big pupil or the small pupil is abnormal.

Related resources

Calgary Guide