In the season 10 Big Bang Theory Comic-Con special, Steve Molaro told a story about how he first met actor Judd Hirsch and was taken aback by his dilated pupil.English singer David Bowie exhibited anisocoria, owing to a teenage injury.This is because a hemorrhage, tumor or another intracranial mass can enlarge to a size where the third cranial nerve (CN III) is compressed, which results in uninhibited dilatation of the pupil on the same side as the lesion. Anisocoria in the presence of confusion, decreased mental status, severe headache, or other neurological symptoms can forewarn a neurosurgical emergency. These cases may be due to brain mass lesions which cause oculomotor nerve palsy. It should be considered an emergency if a patient develops acute onset anisocoria. Old face photographs of patients often help to diagnose and establish the type of anisocoria. This is because Horner's syndrome and oculomotor nerve lesions both cause ptosis.Īnisocoria is usually a benign finding, unaccompanied by other symptoms (physiological anisocoria). If the examiner is unsure whether the abnormal pupil is the constricted or dilated one, and if a one-sided drooping of the eyelid is present then the abnormally sized pupil can be presumed to be the one on the side of the ptosis. Life-threatening, including Horner's syndrome (which may be due to carotid artery dissection) and oculomotor nerve palsy (due to a brain aneurysm, uncal herniation, or head trauma). This may suggest Adie tonic pupil, pharmacologic dilation, oculomotor nerve palsy, or damaged iris.Ī relative afferent pupillary defect (RAPD) also known as a Marcus Gunn pupil does not cause anisocoria.
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