Affected pupil becomes smaller over time.The fellow pupil may become involved later Pupil may be oval-shaped or shows segmental constriction.Affected pupil larger than normal, with decreased response to light but preserved or enhanced near response.Degree of anisocoria remains relatively constant in light and dark conditions.Thought to result from a lesion in the midbrain that disables the pathway for the pupillary light reflex but does not affect the more ventral pathway mediating the near reaction.Usually benign or occurs after surgery, but could also indicate a carotid dissection or neoplasia.Caused by interruption of the oculosympathetic innervation at any point along the neural pathway from the hypothalamus to the orbit.Rare in adults, birth prevalence of 1 in 6250 for those with a congenital onset.When associated with absent or poor tendon reflexes known as Holmes-Adie syndrome.May also be seen in patients with generalised peripheral or autonomic neuropathies Sjögren’s disease and rheumatoid arthritis). varicella zoster) and a number of connective tissue diseases (e.g. Usually idiopathic but case reports of associations with viral infections (e.g.Prevalence 2 per 1,000 of the general population.Most commonly seen in women (2.6:1) aged 20-40 years.Caused by parasympathetic denervation at the level of the ciliary ganglion.Depending on the level of illumination, found in up to 20% of individuals.Unequal pupil sizes in the absence of an underlying pathological cause.Although pupil anomalies are commonly benign, they may be the first or only manifestation of a serious or even life-threatening disorder.
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