Anisocoria

Unequal pupil size, which may represent a benign physiologic variant or a manifestation of disease. Pathologic anisocoria reflects an abnormality in the musculature of the iris (IRIS DISEASES) or in the parasympathetic or sympathetic pathways that innervate the pupil. Physiologic anisocoria refers to an asymmetry of pupil diameter, usually less than 2mm, that is not associated with disease.

Also Known As:

Networked: 118 relevant articles (1 outcomes, 4 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Mydriasis
2.	Pain (Aches)
3.	Horner Syndrome (Horner's Syndrome)
4.	Tonic Pupil
5.	Coma (Comas)

Experts

1.	Kardon, Randy H: 2 articles (08/2013 - 04/2013)
2.	Stegmaier, J: 2 articles (05/2010 - 01/2009)
3.	Mutschler, W: 2 articles (05/2010 - 01/2009)
4.	Lefering, R: 2 articles (05/2010 - 01/2009)
5.	Kanz, K-G: 2 articles (05/2010 - 01/2009)
6.	Huber-Wagner, S: 2 articles (05/2010 - 01/2009)
7.	Hsiao, Chih-Hsien: 2 articles (09/2006 - 06/2006)
8.	Chen, Jiann-Torng: 2 articles (09/2006 - 06/2006)
9.	Lu, Da-Wen: 2 articles (09/2006 - 06/2006)
10.	Chen, Po-Liang: 2 articles (09/2006 - 06/2006)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Anisocoria:

1.	Atropine (Hyoscyamine)FDA LinkGeneric 01/01/2015 - "The diagnosis was based on the presence of anisocoria, the absence of consensual pupillary reaction to the light, weak atropine action on the pupils, well expressed positive results of the VRDL (blood) and RW (liquor) tests, an enhanced signal from the left temporal region in the T-2 regime during MRI, positive hearing dynamics within 12 hours after the onset of anti-inflammatory, antibacterial and infusion therapy. " 08/01/1997 - "[Transient anisocoria after the administration of intramuscular atropine]." 06/01/1993 - "Aerosolized atropine as an unusual cause of anisocoria in a child with asthma."
2.	Pilocarpine (Ocusert)FDA LinkGeneric 02/01/1993 - "This study determines how pupil size, anisocoria, and ambient light influence miotic responses to dilute pilocarpine. " 08/01/2013 - "The main outcome measure was the RAPD, determined by computerized pupillography, at baseline and after pilocarpine-induced anisocoria. " 01/01/2013 - "There was no significant difference between the 2 groups regarding the various pupillary reflex results, including data on the affected pupil size before and after 0.125% pilocarpine, anisocoria, and ratio of pupil decrease. " 01/01/2000 - "Neither hard contact lens fitting nor pilocarpine 0.1% reduced the amount of anisocoria significantly. " 04/01/1997 - "Pilocarpine should not be used to diagnose postoperative anisocoria."
3.	Phenylephrine (Neo-Synephrine)FDA LinkGeneric 09/01/1996 - "Postoperative anisocoria: neurogenic or phenylephrine induced? " 02/01/1993 - "The right pupil of 42 normal subjects was first dilated with phenylephrine to create an experimental anisocoria. " 07/01/1985 - "We report here an unusual cause of anisocoria after anaesthesia: unintended entrance of phenylephrine nasal vasoconstrictor solution into the eye." 01/01/1980 - "In 68.5% of these, anisocoria was induced after applying a drop of neosynephrine. " 08/01/2010 - "Pupillometric studies were performed both in a basal condition (without anisocoria) and after instillation of phenylephrine (a drug with direct sympathomimetic activity) and pilocarpine (a parasympathetic agonist). "
4.	TyramineIBA 06/01/1990 - "The tyramine test resulted in anisocoria with the smaller pupil on the symptomatic side. " 12/01/1984 - "Bilateral instillation of tyramine in the conjunctival sac resulted in a late appearing anisocoria, with the smaller pupil on the symptomatic side. " 06/01/1990 - "A second tyramine test after one week on 75 mg indomethacin per day failed to produce anisocoria. " 05/01/1990 - "Similar to HC, but unlike CPH, topical tyramine in our patient's eyes resulted in anisocoria before, but not after, indomethacin treatment. " 02/01/1988 - "This study demonstrates that in a CH group 2% tyramine (an intraneuronal norepinephrine releaser) instillation into both eyes induces an asymmetric and bilateral mydriasis with the onset of anisocoria characterized by a pupillary diameter being less on the pain-side eye. "
5.	Norepinephrine (Noradrenaline)FDA LinkGeneric 02/01/1988 - "This study demonstrates that in a CH group 2% tyramine (an intraneuronal norepinephrine releaser) instillation into both eyes induces an asymmetric and bilateral mydriasis with the onset of anisocoria characterized by a pupillary diameter being less on the pain-side eye. "
6.	NeurotoxinsIBA 01/01/1997 - "Anisocoria--a pupillary sign of hippocampal lesions: an experimental study in the cat by using neurotoxins."
7.	apraclonidine (Iopidine)FDA LinkGeneric 10/01/2011 - "The anisocoria after dark adaptation and at minimum pupil diameter differed significantly for the measurements obtained 30 and 60 min after instillation with apraclonidine. " 06/01/2006 - "All patients showed a reversal of anisocoria after 0.5% apraclonidine testing. " 06/01/2005 - "In patients with HS, reversal of anisocoria occurs after bilateral instillation of apraclonidine 1% or 0.5%. " 09/01/2015 - "Reversal of anisocoria following instillation of apraclonidine 0.5% has been reported in Horner syndrome caused by lesions of the central and peripheral nervous system. " 03/01/2010 - "This is the first case in which apraclonidine testing has been applied to a patient with a Horner syndrome caused by a lesion in the first segment of the oculosympathetic pathway and the shortest reported interval between clinical manifestations of the lesion and apraclonidine-induced reversal of anisocoria. "
8.	Scopolamine (Hyoscine)FDA Link 03/01/2013 - "Anisocoria from transdermal scopolamine use is an adverse effect that has not been reported in the plastic surgery literature. " 03/01/2013 - "Transdermal scopolamine and perioperative anisocoria in craniofacial surgery: a report of 3 patients." 01/01/2001 - "After extensive neurological 'work up', we realized that the anisocoria was related to the transdermal scopolamine patch that we had prescribed for weaning off the opioid." 01/01/2001 - "Anisocoria from transdermal scopolamine." 05/06/1995 - "[Transdermal scopolamine patches and anisocoria]."
9.	Cocaine (Cocaine HCl)IBA 06/01/2006 - "All patients had an anisocoria greater than 1 mm after 4% cocaine testing. " 04/01/1995 - "Because of the good correlation between post-cocaine anisocoria and anisocoria after 4 s in darkness, photographic or videographic measurements of the pupillary dilatation lag may complete or in some cases even replace cocaine testing." 03/01/1990 - "We compared the cocaine-induced anisocoria in the two groups by measuring photographs of the pupils. " 09/01/1999 - "A 51-year-old man underwent endoscopic surgery of sinuses, and developed anisocoria; likely a result of the local spread of cocaine used to provide local anesthesia and vasoconstriction. " 03/01/1990 - "Through the use of logistic regression analysis, we determined the odds ratio of having Horner's syndrome compared with not having it for each 0.1-mm increment of anisocoria measured after cocaine administration. "
10.	Ipratropium (Ipratropium Bromide)FDA LinkGeneric 11/01/2012 - "[Ipratropium bromide-induced anisocoria during non-invasive ventilation]." 09/01/2008 - "Transient anisocoria caused by aerosolized ipratropium bromide exposure from an ill-fitting face mask." 07/01/1998 - "Transient anisocoria secondary to nebulized ipratropium bromide." 05/01/2014 - "Anisocoria with high dose ipratropium bromide inhaler." 12/01/2005 - "Ipratropium-bromide-induced acute anisocoria in the intensive care setting due to ill-fitting face masks."

Therapies and Procedures

1.	Anesthesia 09/01/2012 - "[Cessation of anesthesia after newly occurring anisocoria without light reflexes]." 02/01/2011 - "Effect of anesthesia in a patient with pre-existing anisocoria." 02/01/1961 - "[Anisocoria and loss of roundness as a clinical symptom of deep anesthesia]." 04/01/2015 - "Anisocoria after anesthesia induction caused by Adie syndrome." 09/01/2012 - "This article reports the case of a patient with known Adie's syndrome where anisocoria led to an unnecessary immediate interruption of anesthesia. "
2.	Intensive Care (Surgical Intensive Care) 11/01/2011 - "Anisocoria is an uncommon entity in general postoperative intensive care. " 03/01/2014 - "This benign cause of anisocoria in the intensive care setting is distinguished from uncal herniation by the laterality of neurologic findings, and lack of mental status change, ptosis, and extraocular movement impairment. " 08/01/1983 - "Pupil sizes were assessed in 100 patients admitted to an intensive care stroke unit over a 1-year period to determine if differences existed and if anisocoria might help in diagnosis. " 03/01/2014 - "Although there are many causes of anisocoria in the intensive care setting, the development of unilateral mydriasis in patients with intracranial hemorrhage or tumor is a neurological emergency, as it may herald the onset of uncal herniation. " 12/01/2005 - "Ipratropium-bromide-induced acute anisocoria in the intensive care setting due to ill-fitting face masks."
3.	Craniotomy 07/01/1996 - "Analysis of the anisocoria-craniotomy latency in ten patients revealed that a lapse of more than 90 minutes was associated with a greater mortality compared with patients with a latency of less than 90 minutes (p = 0.0238, Fisher's exact test). " 07/01/1996 - "None of the patients with an anisocoria-craniotomy latency of 70 minutes or less died and all of these patients had a good or reasonable outcome. " 02/01/2004 - "Data concerning (1) age; (2) gender; (3) mechanism of injury; (4) Glasgow Coma Scale (GCS) on admission; (5) abnormality of the pupils (anisocoria or mydriasis); (6) mean arterial blood pressure; (7) heart rate; (8) time elapsed before craniotomy from injury; (9) initial brain CT scans; (10) duration of craniotomy; and (11) total infusion or urine volume until craniotomy were collected prospectively as IHT risk factors. " 07/01/1996 - "Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients." 08/01/1993 - "Low Glasgow Coma Scale score, anisocoria, fixed/dilated pupils, loss of consciousness, facial or scalp injuries, and age were of no independent value in predicting the need for craniotomy. "
4.	General Anesthesia 04/01/2010 - "Anisocoria after open reduction and internal fixation of a mandible fracture under general anesthesia: a case report." 09/01/1965 - "Anisocoria during general anesthesia." 06/01/2010 - "Two cases of anisocoria that occurred just after the induction of general anesthesia for living donor liver transplantation are reported. " 01/01/2010 - "After the oral surgery under general anesthesia, the patient developed severe anisocoria: in particular, a ~4 mm diameter increase of the left pupil compared to the right pupil. " 01/01/2010 - "Severe anisocoria after oral surgery under general anesthesia."
5.	Photorefractive Keratectomy 04/01/1999 - "[Anisocoria after unilateral photorefractive keratectomy. " 01/01/2000 - "To report the incidence of anisocoria after unilateral excimer laser photorefractive keratectomy (PRK) for myopia and subsequent corticosteroid therapy in a retrospective and prospective study and to explore possible etiologies. "