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Physiologic anisocoria under various lighting conditions.

Ryan P Steck1, Min Kong2, Kaydee L McCray3

  • 1Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, CA, USA.

Clinical Ophthalmology (Auckland, N.Z.)
|January 31, 2018
PubMed
Summary

Anisocoria, or unequal pupil size, is common in healthy individuals across various light conditions. A difference of at least 0.6 mm is recommended to identify true physiologic anisocoria and avoid false positives.

Keywords:
anisocoriapupil diameterpupillometry

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Area of Science:

  • Ophthalmology
  • Optometry
  • Neuroscience

Background:

  • Anisocoria, the unequal size of the pupils, can be a sign of various neurological or ocular conditions.
  • Understanding the prevalence and characteristics of physiologic anisocoria in healthy individuals is crucial for accurate clinical assessment.

Purpose of the Study:

  • To evaluate the measurement of anisocoria in healthy subjects under scotopic, mesopic, and photopic lighting conditions.
  • To determine the optimal pupil diameter difference threshold for identifying physiologic anisocoria.

Main Methods:

  • Pupil diameters of 126 healthy subjects were measured using an infrared pupillometer under photopic conditions.
  • A subgroup of 51 subjects had pupil measurements taken under scotopic (0 lux), low mesopic (0.3 lux), and high mesopic (3 lux) conditions.
  • Anisocoria was defined as a ≥0.4 mm difference in pupil diameter; thresholds were adjusted to ≥0.2 mm and ≥0.6 mm.

Main Results:

  • 23.8% of subjects showed anisocoria under photopic conditions.
  • Prevalence of anisocoria increased under low light: 43.1% in scotopic and 43.1% in low mesopic, 47.1% in high mesopic conditions.
  • Approximately 73% exhibited anisocoria in at least one condition, but only 8% in all conditions. A ≥0.6 mm threshold minimized false positives.

Conclusions:

  • Physiologic anisocoria is prevalent across different lighting conditions.
  • To accurately diagnose physiologic anisocoria, it should be consistently present under all tested lighting conditions.
  • A pupil diameter difference threshold of ≥0.6 mm is suggested to reduce false positives in identifying true anisocoria.