Iritis: This condition causes irritation and swelling around your pupil. Your pupil on the side of the headache may get smaller when you have this kind of headache. If you have a head injury and your pupils change size, you should go to an emergency room.Ĭluster headache: These headaches cause pain on one side of your head. The cause is often unknown, but it sometimes happens after an injury or lack of blood flow.īrain injury: A head injury can sometimes cause your pupils to become bigger than normal or two different sizes. You may have been born with it, but it’s usually caused by something that affects the nerves around your eyes.Īdie syndrome : Sometimes called Holmes-Adie syndrome, it makes one pupil larger than normal and slow to react to light. Horner’s syndrome: This condition makes a pupil shrink. A tumor in this gland can make your pupil bigger. Pituitary gland tumor: This gland controls several other glands that make hormones. If the aneurysm is small, you might not even know it’s there, but it can be dangerous if it grows, ruptures, and leaks blood into the space around your brain. If you also have a headache and double vision, it can be a sign of an aneurysm - a weak area in the wall of a blood vessel. It’s often caused by pressure on one of the nerves that control eye movements. Third cranial nerve palsy: This dangerous condition that can make one pupil dilate. A coloboma in the iris usually leads to the pupil being longer than it should be, sometimes giving it a keyhole-like shape. Though it is rarely the case, it can be a sign of a bigger problem if anisocoria just shows up or the size of your two pupils is suddenly different for no apparent reason.Ĭoloboma: This happens when part of your eye doesn’t form the right way before you’re born. If you don’t have other symptoms, you might compare the size of your pupils with older photos of yourself to try to figure out when it happened. Perhaps the best-known person with this condition was the singer David Bowie, whose left eye was permanently dilated after an injury. Some conditions that can affect your pupils include:Īnisocoria: This is when one pupil is larger than the other. If you notice any sudden change in the size of your pupils and there’s no known reason, see your doctor right away. Sometimes they’ll put medicated eye drops into your eyes to dilate them and make it easier to see into your eyeball. Your doctor also can use what’s called a “swinging light test” to find out if your pupils react to light the same way. For instance, if you’ve had a blow to the head and one or both of your pupils are dilated - larger than normal - that can be a sign of a serious brain injury. The size of your pupils and how they react to light can help diagnose certain health problems. Doctors can look at your pupils for clues about your health. Neuroimaging is not necessarily required if the patient is female, has a history of previous episodes and/or migraines, and the dilated pupil is the only ocular finding.Pupils are the dark-colored openings at the center of your eyes that let light in. The dilated pupil will constrict to 1% pilocarpine, in contrast to a pharmacologically dilated pupil. Specifically, no ptosis or EOM involvement is found and the patient may report previous episodes. The dilated pupil is intermittent, lasting for hours to days, and is the only ocular finding. A brain MRI and MRA were both negative.īenign episodic unilateral mydriasis is most commonly seen in women with a history of migraines. She reported experiencing a migraine 24 hours after our visit and resolution of the dilation after 48 hours. The patient followed up in 3 days at our office and presented at that time with normal pupils (see the second photo). Given the otherwise normal examination and history of migraines, the patient was diagnosed with benign episodic unilateral mydriasis (BEUM).
The attached photo shows the pupils at presentation. The BVA was slightly decreased at distance OS (20/25) and near (J2). Examination was negative for a reverse APD, diplopia, EOM involvement, or ptosis. Otherwise, the patient, who has a history of migraines, was asymptomatic including a lack of headache at the time of presentation. A few hours earlier the patient noted a loss of focusing ability and dilation in the left eye only. A 32-year-old Caucasian female was referred for a unilateral, dilated pupil.
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