Ophthalmology & Optometry/unequal pupils


Hi there ive become aware that my 2 year olds pupils look abit unequal at times, i can notice it more in dim light but there react to light well and equally and dilate well too but sometimes her left pupil looks slightly bigger than her right, shes already under hospital care with eye doctor because shes longsighted and needs to wear glasses she also has a squint in the left eye, can a squint cause the pupil to appear bihger? Ive looked at old photos from when she was a baby and in some the pupil looks bigger than the other so maybe shes had it since birth and ive not been aware of it until now? She went back to the hospital for an eye check up for another worry of mine and dilating drops were used and he checked the backs of her eyes and everything was normal he didnt say anything about her pupils though, she goes back on friday for her 3 month check up with her glasses so i shall mention it there but wouldnt the eye doctor have picked somthing up when he examined her eyes if it were to be anything serious? Iam worrying myself silly over this so looking for abit of reassurance rather tjan being told it could be a brain tumor or horner syndrome which ive read alot about, i dont beleive she has either of thse conditionsas she has no other symptoms and is generally a happy and healthy child excepy for the slight anisocoria.thanks in advance

Hi Danielle   Most anisoconia ( different sized pupils) of sudden onset should be evaluated by a pediatric OPHTHALMOLIGIST or a neuroophthalmologist for a two year old. The good news is that most are idiopathic that is there is no known cause . However you should be aware that anisoconia can be caused by trauma, intracranial bleed, tumor, aneurysm, seizure disorder, migraine, Horners Syndrome, brain abscess, meningitis, to name just a few. Most likely, there would be other signs and symptoms with most of these, not just the pupils size difference. But to allay your anxieties, have the baby thoroughly checked out.   Good luck. Dr Berger  

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Any and all questions with regard to ocular ailments, eye diseases as cataracts, glaucoma, macular degeneration, diabetic retinopathy, etc , eye and visual sympomatology, eyeglasses, contact lenses, low or subnormal vision, pediatric vision conditions,and special and unique ailments will be discussed.


36 years of clinical experience in opticianry and therapeutic optometry. Still in private practice with special interests in vision conditions, diagnosing and treating ocular ailments, prescibing treatment plans which include medicine, eyeglasses, and contact lenses primarily. Although surgery is not within the realm of my area of expertise, I co-manage many pre and post -op surgical cases which include Lasik and PRK procedures.

New Jersey Society of Optometric Physicians American Optometric Association

B.A.,1968, Hunter College of the City University of New York B.S.,1970, Pennsylvania College of Optometry O.D.,1973, Pennsylvania College of Optometry Therapeutic Pharmaceutical Administration Certification, New Jersey 1992

Awards and Honors
Clinical Efficiency Award, 1973, Pennsylvaania College of Optometry

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