Anisocoria - Pupillary Defects - Differential Diagnosis Algorithm



Physiological - Simple Anisocoria ( <O.5mm)

 - Anisocoria equal in light and dark,

 - 10% cocaine: pupils dilate symmetrically

IMPAIRED CONSTRICTION

Preganglionic - Ptosis, opthalmoplegia, Constriction with 0.1% pilocarpine

 • Oculomotor Nerve/Fascicle (Other CN Ill Findings)

Postganglionic - Constriction with 0.1% pilocarpine

 • Tonic (Adie's) Pupil (Ciliary Ganglion Lesion)

Neuromuscular Junction - No constriction with 0.1% pilocarpine

 • Pharmacologic

 • Factitious

IMPAIRED DILATION

Preganglionic - No dilation with 0.125% adrenaline

 • Idiopathic

 • Trauma

 • Tumor (Lung, Breast, Thyroid)

Postganglionic - Dilation with 0.125% adrenaline

 • Cluster Headache

 • Carotid Dissection

 • Trauma

 • Idiopathic



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