Unequal pupils: Understanding the eye’s aperture

Jeffery, Rachael C. Heath; Young, Braden; Swann, Peter G.; Lueck, Christian J.

doi:10.31128/ajgp-07-18-4641

Cited by 9 publications

(3 citation statements)

References 12 publications

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“…It is reasonable to expect that the side of the lesion could factor into which pupil was larger or less reactive. Second, anisocoria may be influenced pharmacologically; 37 our study did not collect data on concurrent medication use. Third, AIP readings were not all taken at uniform intervals (eg, hourly) from every subject, and thus, it is possible that the largest pupillary difference was not captured.…”

Section: Limitationsmentioning

confidence: 99%

Anisocoria Correlates With Injury Severity and Outcomes After Blunt Traumatic Brain Injury

Nyancho

Atem

Venkatachalam

et al. 2021

Journal of Neuroscience Nursing

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BACKGROUND: Automated infrared pupillometry (AIP) has been shown to be helpful in the setting of aneurysmal subarachnoid hemorrhage and stroke as an indicator of imminent irreversible brain injury. We postulated that the early detection of pupillary dysfunction after light stimulation using AIP may be useful in patients with traumatic brain injury (TBI). METHODS: We performed a retrospective review of the Establishing Normative Data for Pupillometer Assessment in Neuroscience Intensive Care database, a prospectively populated multicenter registry of patients who had AIP measurements taken during their intensive care unit admission. The primary eligibility criterion was a diagnosis of blunt TBI. Ordinal logistic modeling was used to explore the association between anisocoria and daily Glasgow Coma Scale scores and discharge modified Rankin Scale scores from the intensive care unit and from the hospital. RESULTS: Among 118 subjects in the who met inclusion, there were 6187 pupillometer readings. Of these, anisocoria in ambient light was present in 12.8%, and that after light stimulation was present in 9.8%. Anisocoria after light stimulation was associated with worse injury severity (odds ratio [OR], 0.26 [95% confidence interval (CI), 0.14-0.46]), lower discharge Glasgow Coma Scale scores (OR, 0.28 [95% CI, 0.17-0.45]), and lower discharge modified Rankin Scale scores (OR, 0.28 [95% CI, 0.17-0.47]). Anisocoria in ambient light showed a similar but weaker association. CONCLUSION: Anisocoria correlates with injury severity and with patient outcomes after blunt TBI. Anisocoria after light stimulation seems to be a stronger predictor than does anisocoria in ambient light. These findings represent continued efforts to understand pupillary changes in the setting of TBI.

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Section: Limitationsmentioning

confidence: 99%

Anisocoria Correlates With Injury Severity and Outcomes After Blunt Traumatic Brain Injury

Nyancho

Atem

Venkatachalam

et al. 2021

Journal of Neuroscience Nursing

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“…En cambio, identificamos afectación de la vía simpática cuando no hay adecuado reflejo de dilatación en la oscuridad en la pupila afectada; la patología más conocida es el Síndrome de Horner y asociada a medicamentos colinérgicos. 7,8,9 Aunque pudiera ser una condición benigna, la importancia del diagnóstico radica en descartar cualquier urgencia neurológica que la pueda acompañar. En la identificación de la causa de la anisocoria, la adecuada exploración pupilar es importante; evaluar la respuesta pupilar y los movimientos oculares, así como signos extraoculares asociado, entre ellos ptosis, anhidrosis y deterioro en el estado de consciencia.…”

Section: Introductionunclassified

“…En la identificación de la causa de la anisocoria, la adecuada exploración pupilar es importante; evaluar la respuesta pupilar y los movimientos oculares, así como signos extraoculares asociado, entre ellos ptosis, anhidrosis y deterioro en el estado de consciencia. 9,10 Se reporta el caso de lactante de 1 año con anisocoria farmacológica súbita que se encontraba ingresado en el servicio de Pediatría en manejo con broncodilatadores inhalados.…”

Section: Introductionunclassified

Anisocoria farmacológica en lactante, asociación con bromuro de ipratropio

Villarreal García,

Ocaña Espinosa,

Martínez Mondragón

et al. 2023

Rev Peru Pediatr

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Introducción. Las causas de anisocoria incluyen traumáticas, compresión del tercer nervio craneal, pupila de Adie, síndrome de Horner, vasculares, toxicológicas, herniación de estructuras cerebrales, fisiológicas y fármacologicas. Reporte de caso. Lactante masculino de 1 año con diagnóstico de neumonía atípica, manejada con broncodilatadores micro nebulizados. Anisocoria súbita con midriasis izquierda a los 3 días de iniciado el manejo con bromuro de ipratropio, sin más hallazgos a la exploración física o exploración neurológica. Tomografía simple de cráneo sin hallazgos relevantes. Se descartó evento neurológico central, se otorgó el diagnóstico de midriasis unilateral farmacológica por bromuro de ipratropio. El manejo incluyó suspensión de micronebulizaciones con bromuro de ipratropio, demostrando resolución a las 14 horas. Comentario. El origen medicamentoso de anisocoria por nebulizaciones en el paciente pediátrico es una posibilidad diagnóstica que el Pediatra debe tener presente.

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