Careful examination can narrow the list of possible etiologies for anisocoria and help the clinician diagnose potentially blinding or even life-threatening disease. Ophthalmic and neurologic etiologies overlap for the optic nerve. Anisocoria can occur with primary ophthalmic disease defined as anterior to and including the retina or it can occur with primary neurologic disease defined as posterior to and including the optic nerve. It is often the first abnormality noted by an owner or detected on a routine physical examination. The remaining ophthalmic examination is unremarkable.Īnisocoria is defined as unequal pupil size. In the right eye there is a negative direct PLR but positive consensual reflex to the left eye in the left eye there is a positive direct PLR but a negative consensual reflex to the right eye. Ophthalmic examination reveals anisocoria with the right pupil larger than the left. Menace reflex is positive in both eyes and direct and consensual pupillary light reflexes (PLRs) are positive however, movement of the left pupil is less due to the initially small pupil size.Ī 10-year-old male/neutered miniature poodle presents for annual vaccinations and wellness examination. Ophthalmic examination of both eyes is normal with the exception of anisocoria (left pupil smaller than the right), smaller palpebral fissure, and partially prolapsed nictitans in the left eye. A 9-year-old female/spayed, domestic shorthair cat presents with the left eye appearing smaller to the owner for 1 week.
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