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International Ophthalmology Clinics 2019
Review
Topics: Adaptation, Ocular; Anisocoria; Humans; Magnetic Resonance Imaging; Photic Stimulation; Pupil
PubMed: 31233420
DOI: 10.1097/IIO.0000000000000276 -
Current Opinion in Ophthalmology Nov 2016Anisocoria is a finding seen on a daily basis in nearly every eye clinic. Although often benign, it can also represent the sole sign of a life-threatening disease making... (Review)
Review
PURPOSE OF REVIEW
Anisocoria is a finding seen on a daily basis in nearly every eye clinic. Although often benign, it can also represent the sole sign of a life-threatening disease making an up-to-date understanding of pathophysiology and diagnosis essential for anyone practicing medicine.
RECENT FINDINGS
Many aspects of the traditional approach to anisocoria still hold true today, but advancements in imaging technology and changing trends in pharmacologic diagnosis and localization have led many to rethink that approach. In addition, the differential diagnosis for anisocoria continuously expands with identification and improved understanding of causal disease processes.
SUMMARY
The present article discusses an approach to the classic anisocoria diagnostic algorithm modified by current knowledge from the most recent literature.
Topics: Algorithms; Anisocoria; Autoimmune Diseases; Autonomic Nervous System Diseases; Diagnosis, Differential; Ganglia, Autonomic; Horner Syndrome; Humans; Neuroanatomy; Oculomotor Nerve Diseases; Tonic Pupil; Trigeminal Autonomic Cephalalgias
PubMed: 27585208
DOI: 10.1097/ICU.0000000000000316 -
Journal of Neuro-ophthalmology : the... Dec 2023
Topics: Humans; Anisocoria; Pupil; Eye Diseases
PubMed: 35421029
DOI: 10.1097/WNO.0000000000001539 -
Der Ophthalmologe : Zeitschrift Der... Jun 2021A 53-year-old female patient presented with increased light sensitivity 3 weeks after oral intake of moxifloxacin tablets for an upper respiratory tract infection. The...
A 53-year-old female patient presented with increased light sensitivity 3 weeks after oral intake of moxifloxacin tablets for an upper respiratory tract infection. The symptoms were anisocoria and the pupils did not react to light or accommodation. The examination of the anterior segment of the eye revealed extensive bilateral iris transillumination defects (ITD). We diagnosed a bilateral acute iris transillumination (BAIT) syndrome. The BAIT syndrome is a rare disorder associated with massive depigmentation of the iris and atrophy of the iris musculature. A risk factor for BAIT syndrome seems to be the oral intake of antibiotics, in particular moxifloxacin after an upper respiratory tract infection but cases of spontaneous occurrence have also been described. Middle-aged women are particularly affected. The exact cause of BAIT syndrome is so far unknown but a potential mechanism involves the concentration of the antibiotic in the vitreous body. Differential diagnoses include other causes for ITD, such as albinism, intraocular inflammation, pseudoexfoliation syndrome and pigment dispersion syndrome. To date there is no specific treatment for BAIT syndrome. Possible complications include increased light sensitivity and post-BAIT glaucoma. Knowledge of the rare BAIT syndrome can be useful in the clinical routine for the differential diagnostic classification of an anisocoria and can possibly contribute to avoidance of unnecessary diagnostic steps.
Topics: Anisocoria; Female; Glaucoma, Open-Angle; Humans; Iris; Iris Diseases; Middle Aged; Moxifloxacin
PubMed: 32588124
DOI: 10.1007/s00347-020-01153-y -
American Journal of Critical Care : An... Nov 2023Anisocoria (unequal pupil size) has been defined using cut points ranging from greater than 0.3 mm to greater than 2.0 mm for absolute difference in pupil size. This...
BACKGROUND
Anisocoria (unequal pupil size) has been defined using cut points ranging from greater than 0.3 mm to greater than 2.0 mm for absolute difference in pupil size. This study explored different pupil diameter cut points for assessing anisocoria as measured by quantitative pupillometry before and after light stimulus.
METHODS
An exploratory descriptive study of international registry data was performed. The first observations in patients with paired left and right quantitative pupillometry measurements were included. Measurements of pupil size before and after stimulus with a fixed light source were used to calculate anisocoria.
RESULTS
The sample included 5769 patients (mean [SD] age, 57.5 [17.6] years; female sex, 2558 patients [51.5%]; White race, 3669 patients [75.5%]). Anisocoria defined as pupil size difference of greater than 0.5 mm was present in 1624 patients (28.2%) before light stimulus; 645 of these patients (39.7%) also had anisocoria after light stimulus (P < .001). Anisocoria defined as pupil size difference of greater than 2.0 mm was present in 79 patients (1.4%) before light stimulus; 42 of these patients (53.2%) also had anisocoria after light stimulus (P < .001).
DISCUSSION
The finding of anisocoria significantly differed before and after light stimulus and according to the cut point used. At most cut points, fewer than half of the patients who had anisocoria before light stimulus also had anisocoria after light stimulus.
CONCLUSION
The profound difference in the number of patients adjudicated as having anisocoria using different cut points reinforces the need to develop a universal definition for anisocoria.
Topics: Humans; Female; Middle Aged; Anisocoria; Light; Pupil
PubMed: 37907374
DOI: 10.4037/ajcc2023558 -
Critical Care Medicine Feb 2022To describe the prevalence and associated risk factors of new onset anisocoria (new pupil size difference of at least 1 mm) and its subtypes: new onset anisocoria...
OBJECTIVES
To describe the prevalence and associated risk factors of new onset anisocoria (new pupil size difference of at least 1 mm) and its subtypes: new onset anisocoria accompanied by abnormal and normal pupil reactivities in patients with acute neurologic injuries.
DESIGN
We tested the association of patients who experienced new onset anisocoria subtypes with degree of midline shift using linear regression. We further explored differences between quantitative pupil characteristics associated with first-time new onset anisocoria and nonnew onset anisocoria at preceding observations using mixed effects logistic regression, adjusting for possible confounders.
SETTING
All quantitative pupil observations were collected at two neuro-ICUs by nursing staff as standard of care.
PATIENTS
We conducted a retrospective two-center study of adult patients with intracranial pathology in the ICU with at least a 24-hour stay and three or more quantitative pupil measurements between 2016 and 2018.
MEASUREMENTS AND MAIN RESULTS
We studied 221 patients (mean age 58, 41% women). Sixty-three percent experienced new onset anisocoria. New onset anisocoria accompanied by objective evidence of abnormal pupil reactivity occurring at any point during hospitalization was significantly associated with maximum midline shift (β = 2.27 per mm; p = 0.01). The occurrence of new onset anisocoria accompanied by objective evidence of normal pupil reactivity was inversely associated with death (odds ratio, 0.34; 95% CI, 0.16-0.71; p = 0.01) in adjusted analyses. Subclinical continuous pupil size difference distinguished first-time new onset anisocoria from nonnew onset anisocoria in up to four preceding pupil observations (or up to 8 hr prior). Minimum pupil reactivity between eyes also distinguished new onset anisocoria accompanied by objective evidence of abnormal pupil reactivity from new onset anisocoria accompanied by objective evidence of normal pupil reactivity prior to first-time new onset anisocoria occurrence.
CONCLUSIONS
New onset anisocoria occurs in over 60% of patients with neurologic emergencies. Pupil reactivity may be an important distinguishing characteristic of clinically relevant new onset anisocoria phenotypes. New onset anisocoria accompanied by objective evidence of abnormal pupil reactivity was associated with midline shift, and new onset anisocoria accompanied by objective evidence of normal pupil reactivity had an inverse relationship with death. Distinct quantitative pupil characteristics precede new onset anisocoria occurrence and may allow for earlier prediction of neurologic decline. Further work is needed to determine whether quantitative pupillometry sensitively/specifically predicts clinically relevant anisocoria, enabling possible earlier treatments.
Topics: Adult; Anisocoria; Brain; Cohort Studies; Female; Humans; Intensive Care Units; Male; Middle Aged; Reflex, Pupillary; Retrospective Studies
PubMed: 34637415
DOI: 10.1097/CCM.0000000000005272 -
Intensive Care Medicine Sep 2020
Topics: Anisocoria; Humans
PubMed: 32219504
DOI: 10.1007/s00134-020-06013-6 -
Journal of the Advanced Practitioner in... 2017
Review
PubMed: 29900014
DOI: 10.6004/jadpro.2017.8.1.2 -
Indian Journal of Critical Care... Nov 2019The realities, recognition, and remedial aspects of anisocoria at the bedside were highlighted by Adhikari et al., which is almost similar to an earlier report from...
UNLABELLED
The realities, recognition, and remedial aspects of anisocoria at the bedside were highlighted by Adhikari et al., which is almost similar to an earlier report from India. Since this condition involves patient safety and clinical assessment, we would like to touch upon 3 Ps (physiological, pathological, and pharmacological) of anisocoria. First and foremost is to elicit a thorough clinical history and then to assess the case in detail which not only rules out injuries, infections, instillation, or ingestion of medicines and instigating mechanisms but also helps rule out various other life-threatening conditions.
HOW TO CITE THIS ARTICLE
Senthilkumaran S, Jena NN, Balamurugan N, Florence B, Thirumalaikolundusubramanian P. Anisocoria: Realities, Recognition, and Remedial Aspects. IJCCM 2019;23(11):543.
PubMed: 31911751
DOI: 10.5005/jp-journals-10071-23279