When does anisocoria occur in a child?

Anisocoria is the different size of the pupils, with one of them giving a normal reaction to the change in illumination, and the other is fixed in one position.

If parents identify a child with such a sign, this can be a reason for great concern. However, it should be remembered that such a phenomenon does not always directly indicate any pathology. If the pupil of one eye differs from the other by no more than 1 mm, then in this case it can be considered the norm and is called physiological anisocoria. It is observed in 20% of absolutely healthy people.

It should be noted that the pupil is not a separate anatomical entity, it's just part of the iris of the eye, which completely absorbs the color. With a high background of lighting, a protective reaction occurs - the pupil narrows, and in the dark it increases, regulating the flow of light particles that enter the eye.

This work is carried out by two types of muscles of the iris - circular and radial, their contraction or relaxation changes the diameter of the pupil. The muscles themselves receive signals from the mesh shell. Under normal conditions, these muscles work the same way. If one of the pupils gives an abnormal reaction, then this is anisocoria.

Anisocoria as a sign of

disease Anisocoria is not a separate nosological unit, an independent disease. But this is a sign of trouble, which can not be overlooked.

Anisocoria in a child can be acquired and congenital. Congenital pathology is associated, most often, with a violation of the structure of the iris. Very rarely such a phenomenon is observed in the underdevelopment of the brain in combination with the corresponding neurological symptoms and developmental lag in the future.

Acquired forms of anisocoria develop due to iris pathology( eye causes) or may occur in disorders related to the nervous system( not eye causes).There is also a separation of a phenomenon such as anisocoria, one-sided and two-sided, but the latter option is extremely rare.

Anisocoria in the infant is most often detected with trauma in the births of the cervical spine, less often as a result of traumatic lesions of the eyeball and inflammatory eye disease.

Often, problems occur that are accompanied by anisocoria in older children. In the end, this leads to disruption of the muscles of the iris:

1. Inflammatory processes provoke infiltration between the fibers, and inflammatory mediators change the ionic composition of the muscle fibers. This reduces the speed of their work.
2. Traumatic eye injury. It leads to a direct violation of the integrity of the fibers of the circular or radial muscles and causes their death. The cause can also be caused by high intraocular pressure. This leads to mechanical impact and disruption of coordination of muscular work and reduction of their contractile function. Injury to the skull. The newborn often exhibits anisocoria with hematoma due to birth trauma. It puts pressure on the brain and disrupts the nervous regulation of the pupils.
3. Diseases of the brain or fascicles of the visual analyzer. This breaks the feedback between the retina and the pupil. Due to the fact that the features of the structure of the neuronal connections in the child are in the developing stage and their final formation occurs only to about six years, and also because of mobility of the cranial bones, the influence of the processes that cause an increase in intracranial pressure in young children rarely invokes anisocoria. In addition, pronounced degenerative or tumor processes are mainly observed in the elderly, so in childhood it occurs most often in the case of congenital infection of the neural pathways in neurosyphilis.
4. Medical anisocoria. The difference in the size of the pupils can occur as a result of instillation with special preparations for the examination of the fundus, such effects are characteristic when the cholinoblockers enter the eye. After a while it passes, as soon as the drug ceases to function.

The cause of anisocoria in children may be a hereditary factor. In order to find out, it is enough to ask about the presence of such a phenomenon in your next of kin. In this case, it is determined by a genetic predisposition and sometimes remains forever, but it may pass with time.

Symptoms of a disease in children

Nevertheless, if a child exhibits congenital anisocoria, especially if it progresses or is combined with neurological symptoms, then it is necessary to consult an ophthalmologist and a neurologist who will conduct a detailed examination and be able to confirm or exclude possible pathological processes.

It is especially important to undergo an immediate examination if, in conjunction with the change in the size of the pupils, there are such phenomena as:

• headache;
• decreased visual acuity;
• nausea and vomiting;
• occurrence of image blurring or its doubling;
• symptoms of fever;
• photophobia.

Neurological causes that cause such a symptom can manifest themselves in different ways. The intensification of anisocoria in bright light signals that the sympathetic innervation of the eye predominates, this is accompanied by mydriasis( dilatation of the pupil), which is due to the defeat of the oculomotor nerve.

Additional symptoms with such a violation are limitation of eye mobility, double vision, divergent strabismus. In this case, the pupil of a larger size is abnormal.

Sympathetic innervation is manifested in anisocoria enhancement in a dark room. Often this occurs when the brain stem structures are damaged and can be accompanied by the descent of the eyelid. At the same time accommodation and convergence remain normal. An abnormal reaction is manifested in the pupil, which is smaller in diameter - it does not expand in the dark.

Only with timely access to specialists, it is possible to detect a pathological condition that causes anisocoria at its early stage, involving all modern types of diagnostics, including MRI, which can significantly affect the course and effectiveness of further treatment. No lotion, bath and other folk remedies for anisocoria can not help.

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