Occasionally, a baby is born with different sized pupils and there is no underlying disorder. If other family members also have this condition, then pupil size is possibly genetic and is nothing to worry about.

At times, for unknown reasons, pupils may differ in size. If there are no other symptoms and if the pupils return to normal, then the temporary condition is nothing to worry about.

Unequal pupil sizes that develop later in life and persist are often a sign of a brain, blood vessel, or nerve disease.

The use of eyedrops are a common cause of a harmless change in pupil size. Other medicines that get in the eyes, including medicine from asthma inhalers, can change pupil size.

Other causes of unequal pupil sizes may include:

• Bleeding inside the skull caused by head injury
• Brain tumor or abscess
• Infection of membranes around the brain caused by meningitis or encephalitis
• Aneurysm
• Excess pressure in one eye caused by glaucoma
• Tumor in the chest or lymph node pressure that may be accompanied by decreased sweating , a small pupil, or drooping eyelid all on the affected side

Treatment depends on the cause unequal pupil size. You should see a doctor if you have sudden changes in pupil size. The new development of different sized pupils may be a sign of a very serious condition.

You should see a doctor if you have persistent, unexplained, or sudden changes in pupil size. The new development of different sized pupils may be a sign of a very serious condition.

If you have differing pupil size after an eye or head injury, get medical help immediately.

Always seek immediate medical attention if differing pupil size occurs along with:

• Blurred vision
• Double vision
• Eye sensitivity to light
• Fever
• Headache
• Loss of vision
• Nausea or vomiting
• Severe eye pain
• Stiff neck

The medical history will be obtained and a physical examination performed.

Medical history questions documenting differing pupil size in detail may include:

• Is this a new finding?
• When did it start?
• What other symptoms are also present?
  • Is there a headache?
  • Is there nausea?
  • Is there vomiting?
  • Is there blurred vision?
  • Is there double vision?
  • Is there a fever?
  • Is there a stiff neck?
  • Are the eyes light-sensitive (photophobia )?
  • Is there eye pain?
  • Is there loss of vision?

The physical examination will include a neurological examination.

Diagnostic tests that may be performed include:

• Blood studies such as CBC and blood differential
• Cerebrospinal fluid studies (lumbar puncture )
• CT scan of the head
• EEG
• Head MRI scan
• Tonometry (if glaucoma is suspected)
• X-rays of the skull
• X-rays of the neck

Depending on the diagnosis, medications may be prescribed including cortisone (to diminish swelling of the brain tissue), anticonvulsant drugs (to control seizures), pain relievers, antibiotics (for bacterial meningitis), or anticancer drugs.