Due to that, most acquired Horner’s syndrome pupils will need neuro imaging to the whole sympathetic chain to rule out compressive lesions or carotid dissection. The pupil develops hypersensitivity (after three to seven days) and installing Iopidine into both eyes will cause reversal of anisocoria as the affected pupil will dilate compared to the normal pupil. Due to difficulties in access to these agents, ophthalmologists could use Apraclonidine (Iopidine) to confirm Horner’s syndrome. Putting this agent into a central or preganglionic Horner’s will cause pupil dilation, however, using this agent in a postganglionic Horner’s pupil will not change the size of the pupil. Hydroxyamphetamine can be used to localise the lesion causing Horner’s syndrome. Cocaine dilates the normal pupil but not the affected pupil so it increases the anisocoria. Various pharmacological agents could be used to confirm the diagnosis and try to localise the site of the lesion. Other features include iris depigmentation in congenital cases. Inhibition of the sympathetic pathway (Horner’s syndrome) – Figure 1: features of this include miosis, subtle ptosis, lower lid reverse ptosis, apparent enophthalmos, dilation lag and anhidrosis.Looking at old photos could help with the diagnosis. It is estimated that up to 20% of the population will have some form of anisocoria. Physiological anisocoria: the difference in size is usually 0.5-1.0mm, the difference is usually similar in light and dark conditions but could be a bit more obvious in dark conditions.This was made more prominent in dark conditions. Note the subtle upper lid ptosis and anisocoria In order to answer this question, pupil size needs to be measured in different light conditions by changing the level of light in the examination room.įigure 1: Horner’s Syndrome in the right eye. Having ascertained the presence of anisocoria, the ophthalmologist needs to answer the next question: which is the abnormal pupil? Question 2: is the smaller or the larger pupil abnormal? It is also important to note any obvious abnormalities in the shape of the pupil. Look at both pupils in ambient room light conditions and measure size of the pupil in each eye. The second question to answer is which pupil is the defective one. The first question facing the ophthalmologist is to ascertain if anisocoria is present or not. It is a sign of an abnormality in the efferent pathway. If the doctor thinks the pressure is too high, he or she will recommend treatment options.Anisocoria means the presence of difference in the size of the right and left pupils. Finally, a spinal tap will be performed, and the pressure of the cerebrospinal fluid (CSF) will be determined.
In some patients, special MRI studies may be used to study blood flow in brain blood vessels. Even though IIH is not reliably diagnosed by using imaging, a CT or MRI scan may be done to ensure that there are no growths, enlarged ventricles, bleeding in the brain, or blood clots causing your symptoms.A neuro-ophthalmologist will check your peripheral vision, your central vision, your ability to distinguish colors, and dilate your pupils to check for swelling of the optic nerves (papilledema).One or more of the following tests are typically used to diagnose IIH and to rule out other conditions: Because IIH diagnosis may be difficult in some patients, a set of criteria, known as the Modified Dandy Criteria, were established to assist physicians.
The people you might see for diagnosis and treatment include:Īny increase in intracranial pressure is cause for concern, and your physician will rule out other disorders before making the diagnosis and offering treatment. You may want to have someone accompany you to appointments to help you keep track. It’s important to keep good notes starting from the first doctor’s visit, because IIH can have a variety of symptoms, and you may see several healthcare practitioners for different symptoms.