The human eye is so unique and necessary "device" that the loss of view is perceived by many as the most terrible tragedy. No wonder vision is considered the main one from the venge of the senses. One of the important features of the eye pupil is considered to change its diameter depending on the level of illumination. That is, the pupil works like a diaphragm - with bright light, it is narrowed, and with a decrease in the level of illumination expands. But there are a number of pathologies in which the diaphragm ceases to work.

What is an aisocoria

The main purpose of the eye pupil to skip the light on the retina eye and adjust its quantity. With bright lighting, the pupil resembles a black point, while the light stream is limited to its small diameter. In order not to lose the sharpness of perception with reduced illumination, the pupil expands so much that the iris becomes almost not visible due to the large diameter of the pupil.

Anisocoria is such a pathological state of the pupil at which it does not react to the change in illumination and its diameter, both in bright light and in the dark, remains unchanged. Anisocoria is not a disease, but arises as a consequence of any negative factors. This defect manifests itself, as a rule, on one eye, while the second eye responds completely normally to changing the illumination.

Experts allocate two forms of this defect:

• Congenital pathology.
• Acquired pathology.

Congenital pathology can be diagnosed in the baby in the first few days after birth. This may be due to the incorrect development of the fetus. In most cases, by 6-7 years, this violation may disappear without a trace, and the pupil begins to adequately respond to a change in illumination.

If the difference between the pupils does not exceed 1 mm and it does not affect visual sharpness, then no intervention is required. This form of anisocoria is diagnosed with each fifth resident of the Earth.

Causes of occurrence

Symptoms of anisocoria

Outwardly, the symptom of this violation is best observed with weak lighting, when the pupil of a healthy eye opens to the maximum value, to skip as much light as possible, and the damaged pupil remains narrowed, and the difference between the diameters of pupils can reach 2-3 millimeters. If the patient's inspection is carried out in a well-lit room, then the difference in the magnitude of the pupils may be inconspicuous. When anisocoria, the pupil of a damaged eye can be in one of two states:

• Pupil is expanded and does not narrow.
• Pupil point and does not expand.

The definition of this is important for accurate diagnosis of the cause of the violation in the eye of the eye diaphragm. Often patients with an aisocoria complain about some associated symptoms. It can be bias in the eyes, strong headaches with an increase in temperature or. The presence of such symptoms makes it possible to diagnose with greater accuracy and assign proper treatment.

Diagnostics

The initial diagnosis of anisocoria is conducting an ophthalmologist, but if these diseases are found, further surveys and treatment are carried out by specialists of another profile. Anisocorium may occur as a consequence of violation of cerebral circulation or stroke. For accurate diagnostics use the most modern methods Research:

• Ultrasound examination.
• X-ray examination of the head and cervical department.
• Electricencephalography brain.
• Magnetic resonance and computed tomography.
• Puncture of the spinal fluid.

Ultrasound examination I. different kinds tomography allow you to reveal the vascular pathology on early stagethat much facilitates the treatment process. Mandatory, in diagnosis, is complete analysis Blood and some medication tests. Usually, a weak solution of pylocarpine is buried in the eye, which has a strong effect on the amazed eye, while a healthy pupil does not respond to the use of this drug. Also, during diagnostics, other drugs can be used, in particular a cocaine solution.

When studying the blood, the main focus is made on increased blood flowability, in which the formation of blood clots is possible and, as a result, a violation of cerebral circulation. The result of this, as a rule, becomes hemorrhage into the brain or stroke. The defeat of the brain associated with oncological diseases also leads to an anisocoria. The reasons that cause an aisocorium may be eye diseases. Most often it is inflammation of the rainbow or vascular shell, glaucoma or herpes.

The effect of anisocoria may occur during traumatic eye damage or during crank and brain injuries. The eye is a very gentle body, so even small injuries can ultimately lead to serious lesions. The resultant cause of an anisocoria is the impact on the nervous system of some drugs of a narcotic row. The absence of an adequate reaction of the pupil on the light stimuli is observed almost all drug addicts.

Even the slightest negative feelings in the eyeball should be a reason for immediate appeal to an ophthalmologist.

Treatment

Since the violation of the pupil function is not considered as a disease, all therapeutic procedures are aimed at eliminating the cause, which caused an aisocorium. In the presence of inflammation of the iris, the eyes are usually used, and antiviral drugs and special ointments can be used during herpes damage. If the anisocorium became a consequence of glaucoma, it is used as medicia treatmentand surgical intervention.

For initial stages Diseases Positive effect can give hormonal drugs, in particular, corticosteroids included in some types eye drops, as well as drugs for internal application. Unfortunately, most of these drugs have negative side effectswhat makes them difficult long use. In addition to surgical intervention, recently, innovative methods are used using laser technologies. Timely and competent treatment allows you to completely get rid of this defect.

In no case should not try to be treated independently or apply eye drops Without consultation with a doctor.

Video

findings

There are no special methods for preventing anisocoria. In production, it is necessary to strictly follow the safety regulations, and use protective equipment during the expropregnum sports. In general, the eyes need just to take care. First of all, you need to lead a healthy lifestyle and completely abandon the bad habits, which include smoking, excessive alcohol consumption and, of course, drugs.

Also, read about what are used to treat conjunctivitis.

Look at your reflection in the mirror: your pupils are the same? Perhaps one of them is much more than the other? If so, then you see such a phenomenon as an anisocorium.

Anisocoria is an asymmetry of pupils, when one of them can be more than usual (expanded) or less than normal size (compressed).

Causes of anisocoria

In many cases, the presence of a light difference between pupils is normal and is not considered an expression of any pathology or a consequence of injury. As a rule, if one pupil is more than one or less than 1.0 mm without an objective reason, it is called physiological anisocorium, benign or simple. It does not affect the appearance of the floor, nor the age nor the color of the human eye, this phenomenon and can be observed from about 20% of the population.

The causes of non-physiological anisocoria (exceeding 1.0 mm) may be the following:

• • The injury of organs of vision, the cranial and brain injury, in which the nerves or sections of the brain may suffer, responsible for the tone of the sphincter and the pupil dlyatator.
  
  
  • The use of local or systemic drug drugs that affect the width of the pupil (eye drops of pylocarpine, and bromide and bromide ipratopia).
  • Inflammation of the iris. Irit (front will take) can cause an aisocorium, which is usually accompanied by pain in the eyes.
  • Ady's syndrome is a benign expansion of the pupil at which it ceases to respond to light. This may be associated with an eye injury, an ophthalmic surgery for cataracts, ischemia of the organ of vision or ophthalmic infection.

Neurological disorders at which anisocoria may arise:

• • Strokes, usually hemorrhagic. Its additional features are a symptom of sails (with breathing inflating cheeks on the side of the brain damage), asymmetry of the eye cracks.
  • Spontaneous hemorrhages or at CMT.
  • Aneurysm.
  • Abscess inside the cranial box.
  • Overpressure in one eye caused by glaucoma.
  • An increase in intracranial pressure due to brain edema, intracranial hemorrhage, acute stroke or intracranial tumor.
  • Meningitis or encephalitis.
  • Migraine.
  • Diabetic nervous paralysis.

Types of anisocoria

The adult anisocorium is most often acquired as a consequence of one of the reasons specified above.

Congenital

Newborn children are often found congenital anisocoria. Most often, it is due to the pathology of the iris, or the weak or defective development of the brain and nervous system.

However, if the child has various pupils from birth, as well as in adult family members, and there are no neurological symptoms, it can be considered such an aisocorium with a genetic feature. In this case, nothing to worry about.

Some physiological difference in the size of pupils in infants, as well as congenital nystagm caused by the imperfection of the nervous system, can be independently corrected up to a year, respectively, the development and strengthening of the bodies of vision and centers in the brain responsible for their innerner. They are eliminated naturally, and the treatment is prescribed only in case of identifying pathology.

Acquired anisocoria in children is often the consequence of injury or in infectious diseases of the brain.

Transient

The change in the size of pupils may be non-permanent and is called transient anisocorium. It is very difficult to put this diagnosis, since symptoms may not appear at the time of the examination. The transient nature corresponds to the moment of the appearance of the main disease, for example, migraine, sympathetic or parasympathetic dysfunction.

The hyperactivity of sympathetic innervation is expressed in a normal or slower reaction of pupils into light, different width of the eye cracks. She is more from the defeat.

Paresis parasympathetic innervation leads to the absence of pupil reactions, and the eye gap from the side of the damage is significantly less.

Diagnostics

Often you can not even suspect that you have different sizes. If this is not due to the presence of pathology, then on the quality of vision, physiological anisocorium is not displayed.

However, if an anisocorium is due to the health problems of the eyes or nervous system, there may be additional symptoms associated with these problems. They include:

• • involuntary omission of centuries (ptosis, partial ptosis);
  • difficult or painful eye movement;
  • pain in the eyeball at rest;
  • headache;
  • temperature;
  • reduced sweating.

At Neuropathologist

Neurological examination is required. People with nervous system disorders that cause anisocoria often also have ptosis, diplopia and (or) squint.

Also, the anisocorium is included in the triad of the classical Horner syndrome: the omission of the century (ptosis is 1-2 mm), MIOSIS (the narrowing of the pupil is less than 2 mm, causing an aisocorium), anhydrosis of a person (violation of the sweating around the affected eye). Usually these phenomena arise when brain injury, tumor or spinal cord damage.

To distinguish Horner syndrome (oculosimpatic paresis) from physiological anisocoria, in the rate of expansion of pupils in the dim lighting. Normal pupils (including normal pupils that are a bit unequal in size) expand over five seconds after the light in the room weakens. The pupil suffering from Horner's syndrome is usually required from 10 to 20 seconds.

Ophthalmologist

The survey at the oculist is carried out to determine the size of the pupils and their reaction to light when lighting and darkening. In a dark room, the pathological pupil will have a smaller size. However, it will be peculiar and physiological anisocoria and horner syndrome. Further differential diagnosis Passing with instilcing in the eye of mydriatics ( medicinesExpanding pupil). In the pathology, the smaller pupil will still remain narrowed and will not succumb to the action of the drug.

When the difference in the magnitude of Zrakov is more in a lit room, then an abnormal accept more pupil. At the same time, the difficulty in motion of the eye can be detected, which indicates the defeat of the III pair of cranial nerves. When maintaining a normal movement of the eyes, a sample with miotic preparations, which should cause a narrowing of the pupil. If this does not happen, then the presence of tonic syndrome ADI, if there is no reaction to the drug, then you can suspect damage to the iris.

Also determine the accommodation and the magnitude of the volume of movement of the eyeballs. Anomalous is considered a more pronounced reaction of the pupil at the accommodative load than with the effects of changes in illumination.

The pathological structure of the eye is detected during biomicroscopy.

You can determine the presence of a permanent anisocoria according to a series of photos of different ages, where pupils and their size are visible.

Treatment

The treatment of anisocoria, which is non-permanent and refers to the pupil disorders in the vegetative syndrome (for example, under meningitis) is also not required.

Congenital vices of iris (hypoplasia or aplasia of the muscles), which contributed to the fact that an anisocorium appeared, they can pass independently with the development of a child, but require observation and, possibly, physiotherapeutic procedures.

If the different magnitude of pupils is caused by damage to the brain, cranial brain nerves, then the tactic how to treat depends on the cause. For infectious inflammation The use of antibiotics is required. In stroke, hemorrhage, hematoma from injury, the presence of a neoplasm need surgical intervention to extract these damaging factors. The usually follows drug therapy, aimed at reducing edema, improving the microcirculation and nutrition of brain cells, restoring neural bonds. Also, with appropriate indication, antitumor and antibiotic drugs are used.

In conclusion, I would like to give an example anisocoria, which is known all over the world - is the eyes of David Bowie. An injury received in his youth made one of his pupil much more than the other. Nevertheless, the experience of the singer showed that life with such eyes is quite successful.

Characteristics of pupil

The specific anatomical structure of pupil is impossible to describe. The pupil is just a hole in the iris through which almost 100% of light rays is absorbed. Back these rays through the iris do not leave and absorb inner shells, which causes the blackness of the pupil from all healthy people.

The pupil acts as a diaphragm of the eye regulating the amount of light feeding on the retina. Under the conditions of brightness, the ring muscles are reduced, radial on the contrary relaxes, which leads to a narrowing of the pupil and reduce the amount of light falling on the retina. This mechanism protects the retina from damage. With insufficient light, radical muscles are reduced, and ring relaxes, which expands the pupil.

Reducing the pupil is carried out by a parasympathetic nervous system, and an increase in sympathetic. In bright light, the sphincter muscle operates, and the dilator muscle is activated during the darkening.

Such changes can occur several times per minute. This is the distribution of photons that irritate the retina. Anisocoria is a consequence of the mismatch of the work of the muscles of the iris. The patient has a different amount of pupils and, accordingly, a different degree of response to lighting.

Overallic nervous muscles of iris allow simultaneous changes in pupils in the eyes. Surprisingly, but if you shine in one eye, pupils will be sown immediately in both, and synchronously. This phenomenon is possible only with the correct operation of the muscles of the iris. If the narrowing in the second eye does not happen, you can talk about pathology. The narrowing of the pupil from the norm is called myiosis, and the expansion, respectively, mydriasis.

It is noteworthy that physiological anisocoria is observed in many fauna representatives. For example, reptiles and amphibians, due to the lack of binocular vision (Pictures perception with two eyes), not always similar synchronicity of the eye reactions.

Pupils are capable of reacting not only on light rays. Many strong emotions (fright, pain and excitement) are capable of influence the size of the pupil. Also some medications Change the process of functioning of the iris.

Classification of pathology and its causes

There are several basic causes of anisocoria that means dozens of various diseases and states. In 20% of cases, an aisocorium in infants is a consequence of a genetic defect. The child most often does not have any other symptoms, and the pathology of the pupil does not exceed 0.5-1 mm. In such cases, the anisocorium may disappear by 5-6 years.

Types of anisocoria

1. 1. Congenital. This type of pathology is often the result of a defect of the eye or its individual elements. The reason affects the muscular machine iris and causes asynchrony in responding to pupils into the light. It happens that congenital anisocoria is a symptom of the underdevelopment of the nervous apparatus of one eye or both, but practically in all cases the pathology is complemented by strabismus.
   2. Acquired. There is a multitude of reasons that can cause an aisocorium during life.

One of the most frequent causes of misunderstanding of pupils are injuries. There are several types of injuries that can cause an aisocoria. First of all, these are injuries of the eye. Often, the synchronicity of the reactions of pupils is disturbed due to damage to the iris or the ligament apparatus of the eye. When the contusion of the eye, when there are no visible damage, the paralysis of the muscular frame structure can develop, the pressure inside the eye will increase.

If the head is damaged, there is always a risk of getting a skull or brain injury. Anisocoria can be the result of a violation of the functionality of the nervous apparatus of the eyes or visual centers in the cerebral cortex. In case of damage to the visual centers, the squint is often developing. Violation spectator nerves It often leads only to one-sided expansion of the pupil. Distinctive feature: the pupil is expanding in the eye of the injury.

Eye diseases are also often manifested through an aisocoria. Such ophthalmologic disorders may be inflammatory and disappropriate. Irites and iridocyclites (insulated iris inflammation) are capable of causing spasms of iris muscles. As a result, the eye ceases to respond to changes in light, which is expressed by the mismatch of pupils. Glaucoma often provokes the narrowing of the pupil in the affected eye (constant): so outflow intraocular fluid It happens faster and easier.

The growth of neoplasms and tumors in the head leads to a weakening of communication between eyeballs and visual centers. As a result, the functionality of the iris is disturbed. Such pathologies can be attributed malignant tumors Brain, neurosophilis, hematoma in the brain after a hemorrhagic stroke.

Anisocoria may appear when exposed to some inorganic substances: Belladonna, Atropine, Tropics. When exposed to these compounds on the nerves and muscles of the eye, the mismatch of pupils may occur.

The diseases of the brain and the nervous visual ways are also in the risk group. Among the main diseases of the central nervous system, which can cause an aisocorium, neurosofilis and mite encephalitis, meningitis and meningoencephalitis can be distinguished.

Types of anisocoria

1. 1. Caused by pathologies of the eye. The state arises due to disorders in the elements of the eye.
   2. Conditioned by other pathologies.

According to the degree of involvement, one-sided and bilateral anisocoria is distinguished. In 99% of cases, one-sided pathology of the eyes is diagnosed, that is, one eye of the normal responds to a change in light, and the pupil of the second either does not respond, or is confused.

Bilateral anisocoria is a rather rare phenomenon. The condition is characterized by a mismatch and inadequate response of iris on changing the visual regime. The degree of pathology can be different for each eye.

Diagnostics of the cause of the defect of the pupil

The first stage of diagnosis of the causes of anisocoria is the collection of anamnesis. The doctor must identify all the accompanying pathologies, study their causes, development and limitation. In the process of diagnosis of anisocoria, patient photography helps. According to them, it is possible to find out whether pathology had before, with what dynamics it developed.

During the examination of the eye, the doctor determines the size of pupils in light and in the dark, the reaction rate, consistency at different conditions Lighting. These simple characteristics help at least approximately determine the cause of the anisocoria and localization of the violation that provokes the mismatch of pupils.

An anisocorium, which is more expressed in bright lighting, about the pathology indicates the expansion of the pupil to large sizes and difficulty narrowing. When anisocoria, more pronounced in a dark environment, the pupil becomes unnaturally small, he is hardly expanding.

Methods of diagnosis of anisocoria

1. 1. Cocaine test. The process uses a 5% solution of cocaine (if the patient is a child, take 2.5% solution). Sometimes the cocaine solution is replaced with an aproaronidine 0.5-1%. The test allows the differentiation of physiological anisocorium from the Gorner syndrome. The procedure is simple: in the eyes dig drops, they estimate the sizes of pupils to the procedure and after 60 minutes. If there are no pathologies, pupils smoothly expand. In the presence of a horner syndrome, pupils on the affected side are expanding to 1.5 mm.
   2. Phenylefrine, tropicid tests. A solution of 1% tropicid or phenylephrine allows you to identify the defect of the third neuron of the sympathetic system, although the first and second defect cannot be excluded. The following procedure: Drops burst into the eye, analyzing the sizes of pupils before and after the procedure (after 45 minutes). The pathology will indicate the expansion less than 0.5 mm. With an increase in an anisocoria by 1.2 mm, we can talk about damage with a probability of 90%.
   3. Pilocarpine test. For the procedure, 0.125-0.0625% pylocarpine solution is used. Pupils with a defect are sensitive to the medium, while healthy eyes do not react to it. Evaluate the expansion of pupils need half an hour after the instillation.

Anisocoria can be combined with such symptoms

1. 1. Pain. It may indicate an expansion or gap of intracranial aneurysm, which is hazardous by the compression paralysis of the third pair of glasses. Also, pain appears during the separation of the aneurysm of a carotid artery. Another cause of pain can be a microvascular eye-minded neuropathy.
   2. Two.
   3. Ptosis and diplopia. May indicate the defeat of the third pair of glaze nerves (cranknogo-brain).
   4. Prottosis (protrusion eyeball forward). It is often accompanied by the volume damage to the orbit.

With suspected anomaly of vessels, contrasting angiography and Doppler ultrasound are prescribed. Diagnosis of violation of the functions of the eye often includes CT, MTP and MSCT with contrasts of vessels. Even if there are no other symptoms, these studies allow to identify aneurysm and brain tumor - the most frequent causes of anisocoria. Neurovisualization studies allow you to determine the exact treatment plan and the need for neurosurgical operation.

Treatment of anisocoria

When anisocoria, which is not due to the pathology of the iris, treatment should be aimed at eliminating the main disease. The incrustration of pupils will disappear independently after successful therapy.

If the cause lies in the inflammatory disease of the brain (meningitis, meningoencephalitis), you need antimicrobial means of a wide range of action, detoxification therapy and measures for the correction of the water-salt balance.

In case injuries, you need to act quickly: no synchronicity in pupils is a bad symptom. Surgical intervention in the skull is often required to eliminate the dangerous effects of injury.

If the mismatch of pupils is caused by injury or eye disease, the therapy is clearer. It is necessary to eliminate pathology and adjust the muscle activity of the iris. The doctor prescribes drugs that directly affect the processes of expansion and narrowing pupils. When Irite and Iridocyclites, cholin-blocking drugs are needed, which relax the muscles of the iris. Long use of such drug can lead to a constant expansion of pupils. Ophthalmologists also assign funds to eliminate inflammation.

With congenital anisocoria, the question of treatment will depend on the degree of violation. Most often requires a few operation to eliminate the eye defect. Rarely, but it happens that the operation is impossible (0.01% of all cases of congenital anisocoria). In this case, patients prescribe eye drops for life.

The reasons

This pathology may occur during injury of the eye, parasympathetic fibers, which innervate the muscle, narrowing the pupil, or sympathetic fibers innervating the muscle expanding pupil.

Anisocoria occurs when the muscle is damaged, which is responsible for the narrowing of the pupil. The pupil is first narrowed, then expands, and is no longer able to react to accommodation and light. As a rule, the reduction of the pupil causes the Irit (inflammation of the iris).

If an anisocorium is enhanced into the light, this is the cause of parasympathetic eye excitation - the mydriasis (expansion of the pupil) is manifested, any reaction of the pupil decreases. In most cases, the main reason for this problem is the damage to the glasses, in which the manifestation of mydriasis can cause limited movement of the eyeball, coolant, ptosis, and divergent squint. The reason for the lesion of the glasses can be aneurysm, a tumor, an acute impaired brain circulation and other severe brain lesions ..


Another cause of parasympathetic denervation may be damage in the eyeflash eyelash of the Ganglia due to infection (slimming herpes), damage to another nature (including in the crank-brain injuries). In this case, the pupil loses the reaction to the light, but a slow reaction to convergence and accommodation remains. When looking away, the pupil slowly expands, doctors call it a "tonic pupil". In the case of EIDI syndrome, a characteristic feature of which is the degeneration of parasympathetic neurons of the ciliary ganglium, such a pupil is combined with a bottle of view, which means a violation of accommodation, and diffuse reduction of tendon reflexes.

When an aisocry is strengthened during the removal from light or even in the dark, it can be concluded that the patient is either a simple anisocorium or a mountain syndrome. This syndrome occurs as a result of damage to the sympathetic innervation of the eye, more often under the lesions of the brain trunk, and characterizes myiosis and ptosis upper century. The position of the eyelids creates the impression that the eye is deep in orbit. The accommodation, convergence and the light of pupils react normally. In most cases, the main causes of the lesion of the sympathetic fibers are large lymph nodes in the neck area, the cervical "edge", tumors on the base of the skull in the eyeboard, carotid artery thrombosis. A simple anisocorium happens most often and is characterized by a small difference in pupils.

Symptoms

Depending on the cause leading to anisocoria, certain symptoms of the damage to the nervous system are determined. Signs of pyramid failure, cerebellum lesions, etc. can be detected.

In all cases, anisocoria, not even accompanied by other symptoms, is recommended to conduct an MRI study in vascular mode or MSCT with contrasts of vessels, because the most frequent cause Anisocoria is aneurysm or brain tumor.

Also, only neurovalization research makes it possible to determine further tactics and helps to solve the issue of the need for urgent neurosurgical intervention.

Treatment

The fact of the presence of an agnosocorium over 2-3 mm is an indication for the advice of a neurologist. Pathogenetic treatment is extremely varied and depends on the specific reason that led to the difference in the size of pupils. Do not delay a visit to the doctor in a long box, because tightening treatment can lead to negative consequences.

Anisocoria is ophthalmological syndromein which pupils have different size. Pathology meets of both sexes, but women are 2 times more often than in men. More characteristic of young age, although it is possible at any age.

The diameter of the pupil affects:

• nervous system (sympathetic and parasympathetic);
• muscles of the Rainbow Shell, responsible for the reduction and relaxation of the pupil.

The effect of the sympathetic nervous system causes the expansion of the pupil, and parasympathetic is narrowing. Sometimes there is a violation of nervous transmission or regulation processes, which leads to different diameter of pupils.

Anisocoria may arise due to violations in the muscular machine iris. When the muscles lose the ability to fully shrink or relax under the action of a number of reasons, the diameters of pupils become different.

Classification

By appearance, anisocoria is divided into two types:

1. Congenital - an aisocorium in infants caused by the underdevelopment of the nervous system or iris.
2. Acquired - arising during life because of some diseases or damage.

According to another classification, the anisocorium happens:

1. Physiological - in healthy people.
2. Pathological - caused by ophthalmological or neurological diseases.

Different diameter of pupils can be a variant of the norm, which is called physiological anisocoria. This case includes the situation when the diameter of pupils differs within 1 mm, there are no other manifestations of diseases, there are no preceding reasons. This is more often found in young people.

Anisocoria in children is often physiological and passes independently after a while.

In what diseases an aisocorium occurs

Anisocoria in adults and children is called alone and the same causes. Conditionally, they can be divided into ophthalmologic and neurological. They are interconnected and intertwined among themselves.

Causes of anisocoria from the eye organ:

1. Eye injury or head with damage to nervous paths or iris muscles. Anisocorium at CMT occurs during damage to the nerves or visual zones of the brain, hemorrhages.
2. Irit is the inflammation of the iris, accompanied by pain, redness, violation of the functions of the muscles of the iris.
3. Some drugs in local or systemic forms: "Pilocarpine", "Bromide" IPratropy.
4. High intraocular pressure In one eye.
5. Benign expansion of pupil with Holmes-Adi syndrome. This syndrome occurs after the operational treatment of cataracts, after mechanical damage, microcirculation disorders, in infectious processes.
6. Oncological neoplasms of eyes or head.

Neurological diseases leading to anisocoria:

1. Bernard-Gunner syndrome is the lesion of the sympathetic system of the sympathetic system.
2. Argail Robertson Syndrome, the cause of which is more often a syphilitic or diabetic damage to the nervous system.
3. After onmk (acute brain circulation disorders). It is more likely when hemorrhagic onMK, when blood circulation is broken due to the breaking of the vessel.
4. Inflammatory diseases of the brain (encephalitis, meningitis, abscess).
5. For sugar diabetes Due to paralysis of nerve fibers.
6. Migraine is a neurological headache, more often one-sided (half of the head).
7. The aneurysm of brain vessels is the absorption of the vascular wall with impaired blood flow and high risk of rupture.
8. High intracranial pressure due to injuries, edema, brain circulation disorders.
9. Paralysis of the III pair of cranial nerves (damage to the glasses with a violation of its functions).
10. Osteochondrosis. With the neck osteochondrosis, the anisocorium is caused by a deterioration of blood flow in the neck vessels and the pinching of the nerves.

Sometimes pupils become different diameters after severe overwork. You should relax, then the symptom quickly passes.

More detailed about anisocoria will tell in the next video of the ophthalmologist:

Symptoms of Disease

Anisocoria in a child or an adult manifests itself equally. The main manifestation is a cosmetic defect: the difference in the diameter of pupils. With a small difference of other symptoms may not be. With great - the following symptoms are possible:

• two-minded items, globally, which leads to a distorted image perception;
• fast fatigue eye;
• headache.

There are signs of inflammation, which is characteristic of infectious pathologies of the eyes: redness, swelling, burning, pain in the eyeballs.

If the cause is in neurological diseases, inflammation of the brain, then high temperature, headache, disorders of consciousness, vomiting, photophobia, disorders of reflexes are noted.

What is possible with neurological syndromes associated with the damage to nerve fibers:

• the omission of the century;
• pulling the eyeball;
• sensitivity disorders;
• reducing sweating on the side of the lesion.

The newborn can be like an isolated manifestation of anisocoria in the form of various pupils and a combination with common symptoms.

Diagnosis of disease

What led to a pathological symptom, will help to understand an ophthalmologist or neurologist.

Survey of a person begins with clarification possible causeswho caused an aisocoria. The doctor clarifies what could lead to pathology, were eye injuries or heads, some diseases that a person received from treatment recently. Then the surveys of an ophthalmic nature are carried out:

• outdoor examination of the eyes with the determination of the reaction of pupils into the light;
• tonometry;
• ophthalmoscopy;
• biomicroscopy;
• diaphanoscopy;
• test with Pilocarpin;
• Ultrasound Eye Apple.

In suspected pathology from the head of the brain or nerve fibers, prescribe:

• MRI brain with the introduction of a contrast agent;
• electroencephalography;
• study of the spinal fluid;
• doppler study of the vessels of the head and neck.

These surveys help to find a lesion site that caused changes in pupils.

In suspected infectious processes, biological fluids for analysis are given, which makes it possible to determine the pathogen.

Methods for the treatment of different pupil syndrome

The need, as well as the amount of therapy, determines the doctor (ophthalmologist or neurologist). As a rule, under innate and physiological anisocoria, treatment is not required.

What will help in one or another situation depends on the main reason. Options for the treatment of anisocoria:

1. Neurostimulation. Effective with neurological damage to nerve fibers.
2. Surgical recovery. Perform with eye injuries, sobbing iris.
3. Anti-inflammatory I. antibacterial treatment uveitis. Prescribed antibiotics in the eye forms: "Floxal", "Tobraks"; Mazi "Tetracycline", "Erythromycin", as well as anti-inflammatory drops: "Diclofenac", "Indocollar". The pronounced inflammation is removed by glucocorticosteroid drops "dexamethasone".
4. Under syphilis prescribe comprehensive treatment In the form of injections and tablets (antibacterial, disintellation, anti-inflammatory means).
5. Inflammatory diseases of the brain are subject to combined therapy with antibiotics, disinfectants, anti-inflammatory and anti-eased drugs.
6. When cancer, the focus is removed, chemotherapy, radiation therapy.
7. Some neurological diseases require hormonal injection therapy.

Complications and forecast

Physiological anisocorium is not dangerous, temporary changes, which speaks of a favorable forecast. And if there are pathologies, i.e. organic lesion No tissues - the forecast is worsening, will depend on the success of the treatment of the main reason.

From complications, eye migraine, impairment of vision, spasm accommodation, secondary inflammation of the vascular shell are possible. In children, another complication is possible - the development of a lazy eye, or amblyopia.

Prevention

There is no specific prevention of anisocoria. What will help reduce the likelihood of syndrome development:

• wearing a protective mask on dangerous work, which helps protect the eyes from damage;
• wearing protection for the head at dangerous work, which protects against the CHT;
• timely examination, competent treatment of eye diseases, infections, pathologies of internal organs;
• keeping a healthy lifestyle.

See additionally the plot of "Live Great" The topic of the popular transmission about different pupils:

What do you know about anisocoria? Did you meet people with different pupils? Leave comments, share an article with loved ones. Be healthy, all the best.

Anisocoria is called a symptom when pupils differ in diameter one from the other. At the same time, the reaction of them is different: one pupil is expanding and narrows, the second is fixed. The reasons for this state are quite a lot: one, the most innocuous, refer to the competence of the oculists, the diagnosis and treatment of others are engaged in neurologists.

What it is?

The pupil is a hole formed by the free edge of the rainbow shell, located not strictly in the middle, but shifted down and inside. Black aperture color determines the mesh shell.

Pupil function - regulation of the number of light rays that will reach the retina. In bright light, the diameter of the opening becomes less, blind rays are cut off, the image acquires clarity, the pupil is expanding in the dark. The muscle expanding the pupil is innervated by the sympathetic nervous system; For the muscles-sphincter "Commander" center is a parasympathetic system. Fear, fright, pain activating the sympathetic nervous system cause and expanding the pupil.

Part of the vegetative fibers comes to the pupil from the nerves, innervating eye muscles and the ciliary muscle. Therefore, when you turn the eye to the nose or when a change in the fixation of the view from a close to a distant object, the pupil also changes its diameter.

Norm

The width of both pupils with a non-survey light is normal - 3-4 mm. With bright light, they must be perpetrated at the same time and equally. If you only send the light on one eye, both pupils should also narrow it equally or with a difference of 0.2-0.3 mm.

Physiological and congenital anisocoria

The difference in the diameter of the pupils of 0.5-1 mm in the absence of any other symptoms is called physiological anisocorium and may indicate congenital features of the iris. Such a feature is observed in 1/5 healthy people.

There is also a congenital anisocorium, which develops as a result:

• anomalies of the eye or its structures; At the same time, in both eyes there may be a different acuity of view;
• underdevelopment of the nervous apparatus of the eye, in this case it is most often available and squint.

An innate anisocorium is observed in a child with almost the moment of birth, is not accompanied by the lag in mental or physical development, increasing the temperature, tightening or familiar vomiting. Often, congenital anisocoria takes place by 5-6 years of life, but may be observed all his life.

In children and adults, the anisocorium sometimes becomes the result of congenital horn syndrome. In this case, the different diameter of the pupil is combined with the omission of the age (usually one, on the eye, where the pupil is already), sometimes with different colors of rainbow shells.

When is it not normal?

The difference in the diameter of pupils is 1 mm and is more symptom of many diseases. Conditionally pathological anisocoria is divided into:

1. developed due to eye diseases;
2. arising due to neurological disorders.

The latter is divided into one that is more pronounced in the dark and such that becomes noticeable in bright light. The reasons for the development of this symptom differ depending on age.

Aisocoria in Brasnikkov

Most often, the cause of various diameters of pupils is the congenital pathology of the iris, or underdevelopment of the vegetative nervous system. Such an anisocorium is present from birth, is not accompanied by drowsiness or, on the contrary, the hyperoportability of the child. May be accompanied by strabismus or omission of the century.

Anisocoria that developed in the infants suddenly may be a sign:

• the aneurysm of the vessels of the cavity of the skull.

Anisocoria in older children

The reason for this symptom may be such pathologies:

1. The injury of one of the departments of the brain.
2. Meningitis or encephalitis, accompanied by edema of the brain (in this case, other symptoms are observed).
3. Eye injury, operations on the internal structures of the eye, during which the iris were damaged or its sphincter.
4. Inflammation of the iris.
5. Poisoning with some poisons.
6. Overdose drugs.
7. Aneurysm of brain vessels.
8. Brain tumor.
9. Eidy syndrome, the cause of which is unknown; It is manifested by one-sided expansion of the pupil with a change in its shape, the absence of a reaction to light and a slow reaction to convergence.

Anisocoria in adults

The reasons for this state in adults are diverse.

1. "Ophthalmic" causes are developing as a result:

• irita and Iridocyclitis;
• transferred to the eye of operations or injuries;
• implanted in the cavity of the lens eye.

1. "Neurological" reasons:

A. With a pronounced anisocoria in the dark. In this case, the "pathological" is considered a smaller pupil:

• gorner Syndrome: A small narrowing of the pupil with the delay of its expansion during the transition to the dark room, the omission of the upper eyelid on the same eye (may be accompanied by a raising of the lower eyelid), reducing the production of tear fluid in this eye, reducing the sweating from this side of the person. Develops syndrome with a huge amount of diseases of the head, neck, and even with a lung tip cancer;
• eydi syndrome - a disease with an obscure cause;
• radial damage to the optical nerve fibers.

B. Aisocoria is more pronounced in bright lighting (in this case, the "pathological" pupil is one that is wider):

• paralysis of the glaze nerve due to aneurysm, stroke, tumor or brain inflammation;
• herpes Herpes in the Ganglia
• the use of sympathomimetics or cholinolithics ("Atropine", "scopolamine", amphetamine, cocaine).

When you should urgently contact the doctor

To the doctor you need to urgently apply if the anisocorium is accompanied by such symptoms:

• With congenital or physiological anisocoria, treatment is not required.
• With inflammatory pathologies, the treatment includes local and systemic antibacterial drugs.
• In tumor formations, operational treatment is shown.
• When meningitis and encephalitis, treatment is complex.

Thus, an anisocorium may occur or with impaired structure of the iris, or with inflammation of the structures of the eyeball (including the pupil sphincter or dilator), or be associated with diseases of the nervous system: its vegetative department, peripheral nerve fibers, central nervous system or Rainbow shell receptors.

In any case, the anisocorium is always a reason for medical advice, and its treatment depends on the identified cause of pathology.

Anisocoria is a disease that is accompanied by a minor difference in the sizes of pupils may also differ and their deformation. Basically, one eye is functioning normally, that is, there is an expansion and narrowing of the round hole in the center of the iris, and the second - has fixed sizes, no changes occur, even when exposed to lighting.

The causes of the anisocoria are diverse, but if the difference is noted in size not more than 0.1 cm, this does not relate to pathology. A disease is diagnosed in different ages, amenable to treatment. Therapy can be comprehensive and appointed based on the results of the survey.

Groups of anisocoria

In modern medicine, three groups of this pathology are distinguished:

1. The pathology of the pupils of a congenital or acquired type, which arose as a result of the defeat of the eye.
2. According to the degree of development: one-sided or bilateral anisocorium.
3. The disease of the eye or non-eye type.

Causes of occurrence

The reasons for the anisocoria will depend on the group to which the pathology of the eye belongs.

Provocative factors:

1. One-sided anisocorium. It occurs as a result of injury almost the entire surface of the pupil. In this case, there is a normal response of one eye to changes, and another marks a late reaction or its complete absence.
2. Bilateral anisocoria. Diagnosed in rare cases. Pathology is expressed in inadequate and inconsistent response of two pupils on any changes in lighting.
3. Congenital anisocorium. Arises as a result of the anomalies of the eye or its sites, such as muscle or iris. Sometimes newborn can observe the incomplete development of the nervous apparatus of one or two eyes at once, that is, an aisocorium, reasons - neurology. The diagnosis is carried out necessarily, the exclusion of therapy leads to negative consequences in the future. In such a situation, this pathology is combined with squint.

Common Procherators

Injury to the eye or disease of the cervical spine, such as osteochondrosis, can lead to such a deviation as an anisocorium. The causes of the appearance are associated with injury damage. This type of pathology progresses due to mechanical damage to the muscular apparatus, which responds not only for the extension, but also for

When osteochondrosis of the cervical spine The round hole in the center of the iris ceases to respond to any differences and levels of light in the outside world.

When there is an increase in the severity of pathology when illuminated, this indicates that the parasympathetic excitement of the eye occurs, and you can also notice the expansion of the pupil. In most situations, the main factor that acts as a provocateur of the disease and problems with eyes is considered to be injured by the glasses. Also, the pupil can stop decreasing in size due to the inflammatory process occurring in the iris.

The consequences of the anisocoria and the causes of the damage to the glasses

The expansion of pupils can provoke such negative consequences as:

1. Split in the eyes.
2. Oblique eyes.
3. Apple movement, but significantly limited.

Damage to the glasses - the main cause of the disease - may arise as a result of such provoking factors as:

1. Aneurysm.
2. New formation.
3. Bleeding in the brain of different types.
4. Damage to the brain or cranial box.
5. Violation of functionality due to the progression of infectious diseases.

In such a situation, the pupil ceases to respond to light, but may be observed in some cases and slower reaction. As for vision, it becomes fuzzy, since there has been a decrease or a complete absence of tenders of tenders occurred. Also very often, the causes of the anisocoria - the horner syndrome, heredity, carotid artery thrombosis.

Pathology of pupils in children

Very often a child is born, which is diagnosed with this eye disease. This is due to the fact that there are already people in the family that suffer from this defect, and the reasons for concern must be completely absent, as this happens at the genetic level, that is, is inherited.

This feature is noticeable immediately after birth and does not provoke any emotional or mental disorders at the kid. Often the difference in the sizes of pupils passes in small patients after 4 years, but mostly remains for life. Sometimes an aisocoria acts as a sign at the same time there are other symptoms of pathology.

The causes of the disease in infants

Why is an aisocorium in a child? Causes are diverse, but not always they are dangerous to life and health. The most common factors include violations of the development of the autonomic nervous system or the hereditary factor. If the difference between pupils arose suddenly, then this may indicate the development of diseases and abnormalities in the brain, as:

1. New formation.
2. Aneurysm vascular system.
3. Injury.
4. Encephalitis.

At the same time, a small patient has a squint or an elevation of the eyelids.

Older children: diagnosis "anisocoria"

The reasons for the appearance in older children are also diverse, and they can be attributed to them:

1. Injury to the brain box or brain.
2. Meningitis or encephalitis.
3. Eye injury, operating interventions that ended in injury to the iris or sphincter.
4. Body poisoning poisons and chemical elements.
5. Inflammatory process of the iris.
6. Aneurysm of the vascular system of the brain or the neoplasm in it.
7. Overdose medicines.

Each deviation will be accompanied by a certain symptomatic.

Diagnosis and treatment

The diagnosis is to properly establish the cause of anisocoria, and also implies a neurological and physical examination. Patient can assign:

1. Research of the spinal fluid.
2. Blood tests.
3. Magnetic resonance and computed tomography.
4. X-ray cervical and brain box.
5. Tonometry.

The examination of patients with this pathology is carried out in a dark and bright room, in turn. Based on the results obtained, therapy is assigned.

The reasons for anisocoria in adults and children can affect the course of treatment. If the disease was not provoked by violation of integrity, the recovery rate is not required.

Mostly, treatment implies the elimination of a provocative factor. Appointed exclusively by a specialist. Independent therapy should be completely excluded, as this may lead to negative consequences.

The recovery rate includes reception:

• medicines that help get rid of migraine and cepalgia;
• corticosteroid preparations for a significant decrease in brain swelling;
• anticonvulsant medicines to control the seizures;
• package, antitumor drugs and antibiotics.

If observed inflammatory process in the brain, it is recommended to use antimicrobial medicines that have a wide range of action, as well as corrective water salt balance in organism. Operable treatment is carried out exclusively when injuring the brain box.