23 answers

Pupil Differences a Concern or Not?

My son has different pupil sizes at times. His left pupil seems to be larger in low light environments. The difference between the two pupils is minimal - I'd say we're talking about a millimeter probably. It's not like one is dilated and the other isn't - like you'd see with brain trauma. It's a slight difference that I noticed for the first time a couple weeks ago when feeding him. I've asked other family members to "look" and 4 have noticed it too but wouldn't have if I hadn't said anything. When I went in for my son's 6 mos check-up, I had the pediatrician look and she said she didn't notice anything at that time but gave me a specialist's name in case I wanted further testing. She looked at two different times (once in a lighted room and once in a darkened room). My main concern is paying to see a specialist and have him tell me that it's normal - making me feel like an over worried or overprotective mom. I guess the only thing that worries me is if it was something and I didn't do anything about it. My husband thinks I should just call the specialist and just discuss it over the phone. But, these days - when do you ever just have a phone consultation with a dr? My question is - is it normal to have teeny differences between pupils?? Anyone else seen this in their children?

What can I do next?

Featured Answers

There's a program called InfantSEE that is run by the American Optometric Association, it's intended to get children in for their first eye appointment before they're 1 year old. The optometrists offer free appointments to kids under 1 - google InfantSEE and you can find doctors that participate. Since they want to see babies that early anyway, I think you shouldn't worry about seeing a specialist at all. If there is a problem, you'll want to start treating it early anyway - my daughter has had glasses since 14 months, and while it hasn't been easy, it's really not too bad (and they're super cute).

Hi J.
My youngest son, who is now 5, has the same thing. His left pupil is noticable larger than his right. At 4 mos old, I had him referred to a specialist. He (the DR) said this happens about 4% in boys and should not affect his vision.
My son seems to be fine and not affected by this. If you are concerned at all, do take him in and see what comes of it.
Good luck! Keep us posted.

More Answers

This happened to me, and we did go to a pediatric specialist. My son had a weak muscle in the right eye, so his eye was slower in dilating to light changes than the other. So, we hd to bandage up the stronger eye, and give the weaker eye a chance to develop stronger muscles. it took the whole summer... but, was necessary, otherwise the weaker eye would've stayed weaker, and the stronger eye would've gotten tired of always doing the work...so, i say, go to the specialist, it is not a quote normal thing, but nothing to ignore, either. always treat things early before they become big things later.

My daughter has the same issue, were one pupil is larger then the other. We talked to her Dr and she said as far as she knew there was nothing wrong, but she isn't an eye Dr. She said because she didn't have a clear answer for me that she recommended my daughter see an eye Dr just to make sure. So we did and found that about 15% of the population has one pupil that is larger then the other and that their eyes are normal. We did discover that she was slightly farsighted, but nothing that required glasses and was more then likely associated with her age, because she is 20/20 now. Now we just go in once a year for a routine eye exam. I will let you know that if you haven't experienced a toddler/infant eye exam, it is interesting.

J.,

I have phone consultations with Dr's all the time - actually their nurses. If it is a stark difference that people notice or his eyes are bothering him, then yes, do something. If it is the smallest difference that only you see, then it is probably just him. The two halves of everyone's face are a little different.

Good luck,
S.

Definatley take your son to a specialist. So what if your being over protective!!! This is about your son's well being, not mention your peace of mind. It could be nothing, it could be something. Point being, is that you are that much concerned, so have it checked out.

I don't know if you've tried this website, but the mayo clinic has a great website that I have found very helpful with unique situations. I don't know if it will have any ideas, but you might want to give it a shot. There are plenty of times that I have talked to my OB or even my sons ped. on the phone. They actually prefer it, sometimes to coming in if it's something that they can take care of verbally. Sometimes it might just by you time until your next appt. Just request the Dr. give you a call back at his/her convenience, and follow-up if you don't hear back in a day. Good luck! Keep us updated.

Hello. I'm not a mom or anything but I am a child. I am 18 years old and a female. I have the same problem as your son and I just wanted to reassure you. Mine only happens in low light or when I am really upset as well. My left eye is the one that is always bigger as well. And it is a very minimal difference. However, the only thing I can say that is different from me and other people with the same size is I don't cry out of my left eye. my eye sight is 20-20 at 18 years old and I have always had this since I was born. My mom too was nervous but now that I am older and she knows that all it affects is my crying she isn't anymore. For your son, I would say he will be okay. No specialist is needed. (=

This happened to my son and I took him in at 18 months old and they said everything was fine. At kindergarten round up he could not read the letter chart with that same eye. I brought him in again and they told me that he had astigmatism and that he was legally blind in that one eye from his brian ignoring that eye due to poor sight. If I had maybe brought him somewhere else this might have not happened to him to such a big degree. We are now in a 3rd year of eye patching to gain back the sight he lost from all that time not being treated. Long story short check him out ASAP.
Good luck!

Definitely go to the specialist. My son's pediatrician noticed that my son's eyes weren't tracking together and refered us to a specialist. When we got there she informed us that our son was totally blind. Hopefully it is not anything to worry about with you son, but pediatricians are NOT eye experts!

There's a program called InfantSEE that is run by the American Optometric Association, it's intended to get children in for their first eye appointment before they're 1 year old. The optometrists offer free appointments to kids under 1 - google InfantSEE and you can find doctors that participate. Since they want to see babies that early anyway, I think you shouldn't worry about seeing a specialist at all. If there is a problem, you'll want to start treating it early anyway - my daughter has had glasses since 14 months, and while it hasn't been easy, it's really not too bad (and they're super cute).

There are a host of reasons this can happen. If only one pupil is dilated, however, you may have Adie's syndrome, a condition in which one pupil contracts more slowly than the other in response to light. It's usually caused either by a malfunction in the mechanism that controls the dilation reflex or from a harmless inflammation of the eye nerves.

More seriously, a single dilated pupil could indicate a brain injury, stroke or tumor.

I'd go see the doctor. It's the best thing to do for your son.

When my son was about this age, I noticed the exact same thing. One pupil would just be a little bigger than the other at different times throughout the day. My doctor explained to me that if there is more light coming from one side it could make the pupil of one eye a slightly different size than the other. My son is 18 months now and has no vision problems. Actually, I'm pretty sure he can see better than me, because he points out things I can barely see! Hope this helps to know someone else noticed (and worried) about the same thing. : )
J.

My brother's pupils are 2 different sizes and always have been. He's never had any problems that were the cause or result of this. My mom just made sure it was in all of his medical records and release forms in case he was ever treated when she wasn't around so the Dr. wouldn't automatically assume he had a head injury.

Go ahead and take him to see the specialist just to make sure there is nothing wrong. I used to work as an EMT and on occasion would treat people who had different sized pupils and nothing was wrong with them, it just happens to some people. Be sure to add this fact to his medical information (and which eye it is) that you keep in your purse in case of emergencies so that EMT's will be aware. As he grows older, make him aware that it is something he will need to tell all medical professionals that he deals with so that they will know that it is his normal.

This probably doesn't help, but its not uncommon during a migraine for the pupils to be different sizes.

This is called congential anisecoria..spelling might be off! My daughter has it and I too thought it was something strange and serious. I had my doctor and my husbands doctor look at her and they both came beack with this. Anisecoria can be a sign of a more serious issue..brain trauma..but if you are noticing it now you might want to try this. Look at him in indoor light even dim light would do..then shine a light in his eyes, if both pupils dialate at the same rate and size it is normal and even has a possiblity of growing out of this issue. My daughters is normal..thank goodness and hopefully your sons is too. If you are really concerned it does not hurt to take him to a specialist to check it out. Better safe than sorry right? Good luck and let us know what you decided and find out...H.

The only time I have ever seen a slightly larger pupil was in my daughter with migraines or seizures. I would at least call and see what they say.

I would not hesitate to take your child to the specialist. Better safe than sorry. You'd probably not have a phone consultation with a doctor/nurse until you've seen that doctor. And even so, it does usually seem like they still want to see them, just to be cautious. Hope everything is OK.

When I get tired, my pupils are frequently different sizes. My mom and sister have it as well, and our vision is not affected in any way. There's a name for it that slips my mind right now (named after a person, I think--not a "medical" sounding name). My uncle (a doctor) noticed it once in all three of us and was astounded because apparently it's quite rare but not something to be worried about.

On the other hand, I'm obviously no expert, and if taking your son to see a specialist would put your mind at ease, definitely do it! It'll be worth it.

Anisocoria can be a symptom of something more serious, but it most likely just a natural variation. I happen to have a fairly noticeable difference between my pupils, as you say, especially when fully dilated. I would start by taking him to an optometrist, which is recommended in the first year anyway. Many optometrists do this free of charge.

If you are in the DSM area, I recommend Dr. Mike at Des Moines Eye Care.
http://www.desmoineseyecare.com/

Hi J.
My youngest son, who is now 5, has the same thing. His left pupil is noticable larger than his right. At 4 mos old, I had him referred to a specialist. He (the DR) said this happens about 4% in boys and should not affect his vision.
My son seems to be fine and not affected by this. If you are concerned at all, do take him in and see what comes of it.
Good luck! Keep us posted.

I am a new mom of a wonderful 5 month old daughter and am also an optometrist. The likelyhood of this being a normal variation is quite high. However, as others have mentioned there are also occassions were it is a sign/symptom of a larger problem. I would encourage you to seek out an InfantSEE provider near your home to have your son evaluated. This provider will be an optometrist who has special interests in seeing children, also the screening program is free of charge. If a problem is detected your son will be referred for further evaluations as necessary.
I hope this helps.
J. M.

I know you have a lot of responses already, but I was just reading in "What to Expect the Toddler Years," book about vision problems (I was wondering how to test toddler's vision) and the book said that one of the "signs" that there might be a vision problem is different size pupils in the same lighting.

I thnk it's worth getting checked out just to rule out any problems. If it is a vision problem, the longer you wait for correction the worse it gets. Like some of the others, I wouldn't go to the pediatrician - find a pediatric opthamologist.

Good luck!

My sons dr. just mentioned this and he is 8 yrs. old. I have never noticed it. He said that it is normal and just to let schools or sports teams know in case something happens they won't mistake this as something else.

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