![]() In rare cases, asymmetry of colour can suggest Horner’s syndrome, with the paler washed-out iris being pathological. Pupil colourĪsymmetry in pupillary colour is most commonly due to congenital disease. Peaked pupils in the context of trauma are suggestive of globe rupture (the peaked appearance is caused by the iris plugging the leak). posterior synechiae associated with uveitis) or previous trauma and surgery. Abnormal shapes can be congenital or due to pathology (e.g. If the difference is more pronounced in dim lighting, this would imply the smaller pupil is abnormal as the larger pupil would then dilate while the pathologically small pupil remains the same size.Įxamples of asymmetry include a larger pupil in oculomotor nerve palsy and a smaller one in Horner’s syndrome. ![]() This is because the normal pupil will constrict in brighter light accentuating the difference in size. If the difference in pupil size becomes greater in bright light such as when facing a window in daylight, this would suggest that the larger pupil is the pathological one. This may be longstanding and physiological or be due to acquired pathology. Note any asymmetry in pupil size ( anisocoria). Pupils can be smaller in infancy and larger in adolescence, then often smaller again in the elderly. smaller in bright light, larger in the dark). Normal pupil size varies between individuals and depends on lighting conditions (i.e. Inspect the patient’s pupils for abnormalities. The pupil is the hole in the centre of the iris that allows light to enter the eye and reach the retina. Abnormal pupillary shape, size and/or asymmetry. ![]()
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