Abstract: Anisocoria, the condition characterized by unequal pupil sizes, presents diagnostic challenges in ophthalmology and neurology. This article provides a comprehensive review of anisocoria, exploring its diverse etiologies, clinical evaluation techniques, differential diagnoses, management strategies, and recent innovations. By enhancing our understanding of anisocoria, ophthalmologists can improve diagnostic accuracy and optimize patient care outcomes.

Introduction: Anisocoria is a common finding in clinical practice, with numerous underlying causes ranging from benign to potentially sight-threatening conditions. Recognizing the various etiologies and implementing appropriate management strategies are essential for ensuring optimal patient outcomes.

Etiology: Anisocoria can result from a wide array of physiological and pathological factors, including variations in pupil size due to differences in iris anatomy, pharmacological effects, neurological disorders, ocular trauma, and systemic diseases. Understanding the underlying etiology is crucial for guiding further evaluation and treatment.

Clinical Evaluation: Evaluation of anisocoria involves a systematic approach, including assessment of pupil size in different lighting conditions, evaluation of pupillary light responses, measurement of near and far pupillary responses, and examination for associated signs and symptoms such as ptosis or ocular motility deficits.

Differential Diagnosis: The differential diagnosis of anisocoria encompasses a broad spectrum of conditions, including benign physiologic anisocoria, Horner syndrome, Adie syndrome, third nerve palsy, pharmacological mydriasis, and others. Differentiating between these entities requires a thorough understanding of their clinical features and associated findings.

Management Strategies: Management of anisocoria depends on the underlying cause and associated symptoms. Treatment modalities may include observation for benign cases, pharmacological interventions for reversible causes, surgical correction for structural abnormalities, and targeted therapy for neurological disorders. Individualized treatment plans tailored to the patient’s specific etiology and symptoms are essential for optimizing outcomes.

Recent Innovations: Recent advancements in the evaluation and management of anisocoria focus on advanced imaging techniques, such as high-resolution pupillometry and infrared pupillometry, which allow for more precise measurement of pupil size and dynamics. Additionally, emerging therapies targeting specific neurotransmitter pathways involved in pupillary regulation hold promise for improving treatment outcomes in certain cases of anisocoria.

Conclusion: Anisocoria is a complex clinical finding with diverse etiologies and management considerations. By staying informed about the latest research and innovations in anisocoria evaluation and management, ophthalmologists can provide personalized care to patients, ensuring timely diagnosis and optimal treatment outcomes.

For further reading and reference:

• American Academy of Ophthalmology – Anisocoria: https://www.aao.org/eye-health/diseases/anisocoria-unequal-pupil-sizes
• Neuro-Ophthalmology Virtual Education Library (NOVEL) – Anisocoria Module: https://novel.utah.edu/collections/undifferentiated/anisocoria/
• British Journal of Ophthalmology – Anisocoria: https://bjo.bmj.com/content/104/7/1027