Unequal pupils differential diagnosis. It can also be a medication side effect.

Unequal pupils differential diagnosis H57. Complete Differential Diagnosis of Anisocoria. As a clinician, it is important to determine whether a patient with anisocoria can be reassured or requires referral for further Anisocoria is a condition in which the pupil of one eye differs in size from the pupil of the other. Ms BR groaned in response to a painful stimulus, had unequal pupils (left, 5 mm and reactive; right, 6 mm and sluggishly reactive), absent corneal reflexes, present gag and cough reflexes, Differential Diagnosis. 3. [2]Anisocoria has various causes: [3] Physiological anisocoria: About 20% of the population has a slight difference in pupil size, which is known as physiological anisocoria. vomiting. It is primarily acquired following damage to the sympathetic nerve supply, but rare cases of congenital forms have been seen. Differential diagnosis. Anisocoria (unequal pupils) Anisocoria: small versus large pupils Author : LAURENT GAROSI Categories : Vets Date : July 28, 2008 LAURENT GAROSI explains how pupils are a vital window into the neurologic status of animals’ nervous systems THE pupil is an important indicator of the neurologic health of the central and peripheral nervous systems. 2017 Feb 23;356:j643. Unequal pupils themselves usually cause no symptoms, but occasionally a person may have Anisocoria is a condition defined by pupils of unequal sizes Stepwise approach to the examination of anisocoric pupils to guide a differential diagnosis and management. Pilocarpine) Mydriasis (pupil dilatation) of one, but not Swing a light back and forth in front of the two pupils and compare the reaction to stimulation in both eyes. 09 became effective on October 1, 2024. Diagnosis. caused by neurologic disease, unequal pupil size may result from malfunction of the sympathetic, parasympathetic, or visual systems. When light reaches a pupil there should be a normal direct and consensual response. A flow chart for sorting out the anisocorias. 4 mm is found in up to 20% population. Uniocular double vision has a much narrower differential diagnosis. The varied causes have implications ranging from life threatening to completely benign, and a clinically guided history and examination is the first step in establishing a diagnosis. [1] It is usually associated with tissue excavation, infiltration, and necrosis. Non-reactive pupils should suggest, in the right clinical setting and among other possibilities, the diagnosis of MFS. This review discusses the differential diagnosis of a large pupil (anisocoria more obvious in the light) and a small pupil (anisocoria more obvious in Anisocoria, or unequal pupil sizes, is a common condition. A fixed dilated pupil in an awake patient is NOT due to herniation. However persistent anisocoria seems to be rarer, in the same study it was only found in 3% subjects 1 Anisocoria, or unequal pupil sizes, is a common condition. A doctor may need to make a differential diagnosis — that is, determining whether the patient has Adie’s tonic pupil or another condition that can cause similar symptoms. Ritter Establish if the diplopia is binocular or not. The main designs were retrospective or prospective descriptive studies and reviews. Additionally, dilation of the pupil is termed mydriasis and constriction of the pupil is termed miosis. Causes, differential diagnosis and clinical implications of anisocoria. . Pain on pupillary constriction. She had visited her primary care doctor because of an upper respiratory tract infection and was unconcerned about her unequal pupil size (anisocoria), stating that she “has had odd pupils and a droopy Deviation from this suggests abnormalities. [4] Anisocoria is a term derived from two Greek words, “aniso-” meaning unequal, “kore” meaning pupil, and a Latin suffix “ia” meaning abnormal condition. 2017 Oct;53(10):1024-1025. The differential diagnosis is crucial and may be the difference between life and death, especially in the context of BAO. Even with [Unequal pupils] Duodecim. It is important to get a prompt diagnosis because some of the causes of the issue are life-threatening. Review of systems seeks symptoms that may suggest a cause, such as birth defects or chromosomal abnormalities (congenital defects); droopy eyelid, cough, chest pain, or dyspnea (Horner syndrome); genital lesions, adenopathy, rashes, or fever EMS Medical/Trauma Pathopysiology and Differential Diagnosis Practice. Take time to clarify the symptom. 6:1) for the idiopathic variety (Adie tonic pupil). Find out about the possible causes of anisocoria here, as well as when to seek emergency treatment. Scleritis. 1111/jpc. iritis; cervical sympathetic paralysis; miotic drug (e. In cats, the pupil is an elliptically-shaped opening in the middle of the iris that allows light to pass through the eye to the retina. irregular breathing. 09 may differ. An injury or lesion in either pathway may result in changes in pupil size. A 73-year-old woman presented with asymmetrical pupils. Activity recording is turned off. Heath Jeffery RC, Young B, Swann PG, Lueck CJ. Lesion localization is critical to developing an appropriate differential diagnosis list. The typical presentation of Horner This review discusses the differential diagnosis of a large pupil (anisocoria more obvious in the light) and a small pupil (anisocoria more obvious in the dark), and discusses the relevant afferent pupillary defect, in which there is no anisocoria One pupil being noticeably bigger (more dilated) than the other is the most obvious anisocoria symptom. [Article in Finnish] Author E Mustonen 1 Affiliation 1 Department of Ophthalmology Diagnosis, Differential Humans Iris Diseases / diagnosis Iris Diseases / etiology Although migraine is one of the most common causes of headache other entities should be kept in mind in the differential diagnosis of intermittent headache. Approximately 20% of the population have anisocoria unrelated to any medical abnormality. Although patients of all ages are affected, the mean age is 32 years, and there is a female predominance (2. Examine the pupils for reactivity, size, and symmetry. Thompson HS, Pilley SFJ (1976) Unequal pupils. The cover test is a reliable way to find out which eye is affected. The pupils should be equal in size (although up to 20% of normal individuals have unequal pupils (anisocoria)). The pupil constricts or dilates (enlarges) according to the amount of light that enters the eyes, with both An unequal size of the pupils, an unusual shape, white colored pupils, The differential diagnosis can be narrowed if the location of the lesion is known or suspected. On history and examination, we need to decide if the patient can be clinically Pathologic anisocoria reflects an abnormality in the musculature of the iris or in the parasympathetic or sympathetic pathways that innervate the pupil. Get expert advice on how to manage and support your child if they have Some examples of drugs which may affect the pupils include pilocarpine, cocaine, tropicamide and scopolamine. Episcleritis. Question Answer; Chest (< 90 systolic), narrowing pulse pressure, dull and dilated pupils, diaphoresis, cyanosis, orthostatic vitals: Decompensated Shock: Irregular breathing pattern, widening pulse pressure, bradycardia, non-reactive or unequal pupils, amnesia Differential Diagnosis. If there are no other symptoms and if the pupils return to normal, then it is nothing to worry about. After full history, What they find during the history and physical examination often suggests a cause of the unequal pupils (see table Some Causes and Features of Unequal Pupils) and the tests that may need to be done. Unequal pupil size, or anisocoria, is a condition in which the pupils are different sizes at the same time. Anisocoria (Unequal Pupils): Read more about Symptoms, Diagnosis, Treatment, Complications, Causes and Prognosis. The differential diagnosis includes compression of the third cranial nerve, Adie's pupil, tentorial herniation, and meningeal irritation and inflammation. This article explores the causes of unequal pupils and discusses the available treatment options. Pre-existing ocular or neurological injury, or topical or systemic medication, may cause pupillary asymmetry, or even a fixed dilated pupil (e. 280. Overview and Facts about Unequal Pupil Size. - StatPearls [Table, Differential Diagnosis]. This review discusses the differential diagnosis of a large pupil (anisocoria more obvious in the light) and a small pupil (anisocoria more obvious in the dark), and discusses the relev Unequal pupils: Understanding the eye's aperture Aust J Gen Pract. Pilocarpine) Mydriasis (pupil dilatation) of one, but not Making a Diagnosis. In this condition, the difference between pupils is usually less than 1 mm. Sometimes, patients complain of ‘double vision’ when they really mean blurring – and vice versa. coloboma), iris inflammation or trauma, Argyll Robertson pupils. Epidemiology. Differential diagnosis from craniosynostosis was often described [24, 33, 36, 51]. Unequal pupil after sinus surgery is uncommon; however, it could equally The possibility of viral encephalitis or tuberculous meningitis must be considered as differential diagnoses in children with meningeal signs. The causes can range from benign to life-threatening. parasympathetic involvement in a compressive third nerve palsy). 2_13531. MeSH terms Diagnosis, Differential Dilatation* Eye Diseases / diagnosis* Anisocoria, or unequal pupils, can be a physical trait or a sign of eye, nerve, or brain damage. 25 Anisocoria is defined as inequality between pupil diameters. The absence of characteristic features of glaucoma, such as the typical visual complaint of “seeing halos around lights” and an isolated recording of normal intraocular pressure, does not exclude this diagnosis. The 2025 edition of ICD-10-CM H57. 4 mm or more between the sizes of the pupils of the eyes. Article CAS PubMed Google Scholar Thompson HS, Newsome DA, Loewenfeld IE (1971) The fixed dilated pupil: sudden iridoplegia or mydriatic drops? A simple diagnostic test. Understanding the potential causes and seeking appropriate treatment can help improve eye health and overall well-being. Unequal pupils and ptosis BMJ. Doctors ask when the person However, location of the lesion and diagnosis of the problem can be difficult. Uveitis. Authors David Ce Ng 1 , R P Shangkeree 1 , Erwin J Khoo 2 Affiliations 1 Department of Diagnosis, Differential Female Anisocoria is a term derived from two Greek words, “<i>aniso</i>-” meaning unequal, <i>“kore”</i> meaning pupil, and a Latin suffix <i>“ia”</i> meaning abnormal condition. As ophthalmologists, we all need to have a practical plan for assessing patients with unequal pupils. Causes. Author Andrew Malem 1 Diagnosis, Differential Emergency Service, Hospital Bilaterally small and irregular pupils with a near response markedly better than the light response (also known as “light-near dissociation”) are known as Argyll-Robertson pupils. Other less common causes include iatrogenic injury (10-18. Examination checklist. If a person's pupils are symmetric there is said to be isocoria. 09 - other international versions of ICD-10 H57. Differential Diagnosis: General. If that’s the case, you still need to visit an eye care specialist to have the change in When the light source was turned off, the miotic left pupil did not dilate, raising concern for a pathologic small pupil. Anisocoria, or unequal pupil sizes, is a common condition. Tonic (Adie) pupil. The medical term for pupils of different sizes is anisocoria. Other causes of unequal pupil sizes may include: Aneurysm in the brain; Bleeding inside the skull caused by head injury; Brain tumor or abscess (such as pontine lesions) Differential Diagnosis: General Findings: Miosis (Pupil Constriction) of one, but not the other Findings: Mydriasis (pupil dilatation) of one, but not the other BACKGROUND: Unequal pupils (anisocoria) may be physiological, pathological or pharmacological. 10. Examination of the pupils is therefore a crucial part of any eye examination. The differential of conditions causing anisocoria may be divided into three sub-categories, depending upon whether Generally, anisocoria is caused by impaired dilation (a sympathetic response) or impaired constriction (a parasympathetic response) of pupils. Download Citation | The differential diagnosis of fixed dilated pupils: A case report and review | This case report describes a patient with Guillain-Barré syndrome in whom the presence of coma Learn about unequal pupils in children, a condition known as anisocoria, and what parents should know. The Paredrine test refers to using 1% review discusses the differential diagnosis of a large pupil (anisocoria more obvious in the light) and a small pupil (anisocoria more obvious in the dark), and discusses the relevant afferent pupillary defect, in which there is no anisocoria but both pupils react differently depending on which eye is illuminated. congenital; tabes dorsalis; trigeminal neuralgia Unequal pupils CONTENTS 276 Introduction. 09 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Therefore, among causes of papilledema the following disease entities must be considered: Intracranial mass lesions (tumor Learn the facts about medicine at http://www. Skip to content; Accessibility help; Search CKS Skip to content. Anisocoria with normally reactive pupils Differential diagnosis • common – physiologic anisocoria – Horner syndrome • uncommon: intermittent pupillary mydriasis of young (some cases) unequal pupil size, which may represent a benign physiologic variant or a manifestation of disease. Inflammatory. 2. congenital; tabes dorsalis; trigeminal neuralgia; carotid aneurysm; aortic aneurysm; unilateral intracranial mass; glaucoma; Adie's Pupils; Miosis (Pupil constriction) of one, but not the other. 79. More often, unequal pupils are noticed only during a doctor's examination. Importantly, anisocoria can indicate Suspect herniation due to an intracranial mass lesion as a cause of fixed dilated pupil in an unconscious patient. 2017 Oct;53(10):1026. J Neuroophthalmol. Abnormal pupils Anisocoria: Anisocoria means unequal pupils. Physiologic (also known as simple or essential) anisocoria is the However, the most concerning condition in the differential diagnosis of a child with anisocoria is Horner syndrome, a loss of the sympathetic tone to the eye (oculo-sympathetic paresis). Non-infectious conjunctivitis: Atopic or allergic conjunctivitis — may be recurrent due to seasonal or environmental factors. Discuss approach to diagnosis of anisocoria. If you notice that your pupils are unequal in size, see a doctor right away. Pharmacologic blockade is the most common cause of a fixed dilated pupil in an otherwise normal healthy patient. It can also be a medication side effect. Differential Diagnosis. Importantly, anisocoria can indicate underlying disease of the eye, orbit, brain, neck or chest. Unilateral pupil dilation during or after sinus surgery may be due to trauma to the oculomotor nerve. IIH is usually a diagnosis of exclusion. This phenomenon results due to disturbances in the efferent pathway Unequal pupils (anisocoria) may be physiological, pathological or pharmacological. Approach to anisocoria. At this point, the differential diagnosis for anisocoria included pathologies causing Horner syndrome, As ophthalmologists, we all need to have a practical plan for assessing patients with unequal pupils. g. Keratitis. doi unequal pupil size, which may represent a benign physiologic variant or a manifestation of disease. Arch Ophthalmol 86:21–27 If the anisocoria is greater in the dark but the miotic pupil does not react to light, this excludes a Horner pupil and expands the differential diagnosis to parasympathomimetic pharmacologic anisocoria, chronic miotic Adie tonic When anisocoria is present, the ophthalmologist knows that something is wrong. Anisocoria is a condition, characterized by unequal pupil sizes. FIGURE 1. Diagnosis of the cause of unequal pupils involves a comprehensive physical examination, including an eye examination and a neurological examination. unequal pupils. This is the American ICD-10-CM version of H57. doi: 10. Unequal pupils and ptosis. If unequal, ask the patient if this is normal for them (eg, congenital Horner's syndrome) or a new finding. Causes of anisocoria (unequal pupil size) range in seriousness from a normal, physiologic condition to one that is immediately life threatening. Corneal ulcer, abrasion or foreign body. 2_13531 No abstract available Diagnosis, Differential Female Anisocoria, or unequal pupil sizes, is a common condition. [Unequal pupils] Duodecim. Equal (Horner’s may produce unequal pupils) Consensual reflex; Relative afferent pupillary defect; Extra-ocular movements (in which direction is the diplopia maximal) Although Horner syndrome can result from a variety of mechanisms (Table 1), the most common etiologies are neoplastic (35-60% of all cases). 5% apraclonidine (alpha-2 agonist) eye drops which will dilate the miotic pupil and correct the anisocoria. 1996;112(2):79-81. 277. The varied causes have implications ranging from life threatening to completely benign, and a clinically guided history and examination is the first step in establishing a Unequal pupils and ptosis. 1136/bmj. 927. Management flowchart. History of present illness includes the presence, nature, and duration of symptoms. If there is a good reaction to light in both eyes but a poor dilation in the dark then the affected pupil is abnormally small. 1_13531. Understand the importance of early diagnosis and treatment to prevent potential complications. • Differential diagnosis - congenital defects (e. Ø In the absence of any deformities of the iris or eyeball, Horner syndrome is a rare condition classically presenting with partial ptosis (drooping or falling of upper eyelid), miosis (constricted pupil), and facial anhidrosis (loss of sweating) due to a disruption in the sympathetic nerve supply. 1 More importantly, it may be a sign of a potentially life-threatening condition from raised intracranial pressure, secondary to intracranial space occupying lesion, intracranial haemorrhage, Learn about the process of diagnosing unequal pupils during an eye examination. congenital; tabes dorsalis; trigeminal neuralgia; carotid aneurysm; aortic aneurysm; unilateral intracranial mass; glaucoma; Adie's Pupils; Miosis Unilateral dilated pupil in a critical patient under sedation is an important clinical sign that requires prompt evaluation. Unequal pupil sizes of more than 1 mm that develop later in life and do not return to equal size may be a sign of an eye, brain, blood vessel, or nerve disease. Introduction Differential diagnosis. This review describes the oculo-visual problems likely to be encountered in Parkinson’s disease (PD) with special reference to three questions: (1) are there visual symptoms characteristic of the prodromal phase of PD, (2) is PD dementia associated with specific visual changes, and (3) can visual symptoms help in the differential diagnosis of the parkinsonian Anisocoria with pupils that do not constrict normally to light. j643. Keywords: basilar artery occlusion, coma recovery, dilated pupils, endovascular treatment, ischemic stroke. Anisocoria (unequal pupils) may be physiological (simple or essential) or secondary to conditions related to the eye, such as post ocular trauma/eye surgery or oculomotor nerve paralysis. Adie's Syndrome; Alcohol intoxication; Aniridia; Argyll Diagnosis, Diagnosis, Red eye, CKS. In a patient with a red painful eye, Anisocoria, or unequal pupil size, is a concerning physical exam finding with a broad differential, ranging from benign to life threatening conditions. On history and examination, we need to decide if the patient can be clinically diagnosed and reassured Anisocoria with normally reactive pupils Differential diagnosis Variable (pupils sometimes equal) Horner syndrome: Pupils always unequal: Worse in dim light: Ptosis on side of smaller pupil: Possible decreased sweating of face on affected side: Unequal pupil color in congenital or early acquired cases: Associated with some systemic disorders: Neuroblastoma: Thoracic or cervical surgery: Birth trauma with Unequal pupils in an asthmatic child. 6. PMID: 28975749 DOI: 10. Turn recording back on. Other medicines that get in the eyes, including medicine from asthma inhalers, can change pupil size. 2005 Jun. congenital; tabes dorsalis; trigeminal neuralgia The use of eye drops is a common cause of a harmless change in pupil size. inability to drink or breastfeed. Pupil size (in mm A diagnosis of Horner’s can be confirmed by administering 0. Discharge can be an important clue to differential diagnosis of red eye. It can be physiological as well as pathological, occurring due to numerous causes, unequal pupil size, which may represent a benign physiologic variant or a manifestation of disease. net/ A 69 year old woman was referred by her primary care doctor to the eye emergency department with a dilated left pupil and ptosis of her right upper lid. Pathologic anisocoria reflects an abnormality in the musculature of the iris or in the parasympathetic or sympathetic pathways that innervate the pupil. Ms BR’s clinical presentation was consistent with global cerebral edema caused by acute hyponatremia. Diagnostic tests are often needed as well. unequal pupil size, which may represent a benign physiologic variant or a manifestation of disease. 4 Although the miosis is bilateral, it is often asymmetric, and these pupils are typically very difficult to dilate, which can help confirm the diagnosis. The patient had a history of bilateral cataract As previously described, anisocoria was defined by a difference of 1 mm or more between the size of the two pupils and pupillary areflexia (nonreactive pupil) Pupillary evaluation for differential diagnosis of coma. However, the presence of anisocoria can, in certain cases, can be a sign of an underlying medical Unequal pupils: Understanding the eye's aperture. numbness, ataxia, dysarthria, or weakness help narrow the differential diagnosis. physiologic anisocoria If pupil sizes are very unequal, a person may notice the discrepancy. Unequal pupils in an asthmatic child J Paediatr Child Health. 1 When anisocoria is caused by neurologic disease, unequal pupil size may result from malfunction of the sympathetic, parasympathetic, or visual systems. 5%) and trauma (4-13% inclusive of birth-related injuries). congenital; tabes dorsalis; trigeminal neuralgia This review discusses the differential diagnosis of a large pupil and a small pupil and discusses the relevant afferent pupillary defect, in which there is no anisocoria but both pupils react differently depending on which eye is illuminated. However, location of the lesion and diagnosis of the problem can be difficult. Learn about possible causes and treatment options. Topical apraclonidine in the diagnosis of suspected Horner syndrome. 23 A simple way to localize Horner syndrome is to note the extent of anhidrosis and The differential diagnosis for infective conjunctivitis includes: Serious conditions such as: Acute glaucoma. congenital; tabes dorsalis; trigeminal neuralgia Anisocoria is a common condition, defined by a diameter difference of 0. Find out what to expect during the examination and how it can help in diagnosing various eye conditions. A step-by-step flow chart for diagnosis of unequal pupils is presented, with explanation of various signs and descriptions of appropriate diagnostic tests. Its origin may be physiological, pathological or drug related, making it important for emergency providers (EP) to perform a thorough history and physical examination to ensure early intervention and prevention of Differential Diagnosis: General. [Table, Differential Diagnosis]. rigid posture or posturing. Localize the lesion responsible for anisocoria. The term papilledema usually suggests disc edema/swelling secondary to elevated intracranial pressure, which can have many etiologies in addition to IIH. In alphabetical order . Determine whether one or both pupils are abnormal in size 2. Multiple sclerosis; Giant cell arteritis; Mononeuritis multiplex; Miller-Fischer syndrome; Pupils. A corneal ulcer is a corneal epithelium defect involving the underlying stroma and is potentially a vision-threatening ocular emergency. An RAPD is diagnosed by observing However, when combined with “differential diagnosis” or “screening,” the result decreased to less than 20 each. You might not experience other symptoms. Conditions that may have similar signs and symptoms include: botulism, paralysis of the third facial nerve, Guillain-Barre syndrome, Horner’s syndrome , and multiple sclerosis (MS). Understand the tests and procedures involved in determining the underlying cause of unequal pupils. 49 [PMC free article] [Google Scholar] 5. A fixed oval pupil in association with severe pain, a red eye, a cloudy cornea and systemic malaise suggests acute angle closure glaucoma which warrants immediate referral. 1136/pmj. Find out the possible causes, symptoms, and when to seek medical attention. 279. Look for a history of: convulsions. 2019 Jan-Feb;48(1-2) :39-42. Postgrad Med J 2003;79:49-51. When evaluating patients with asymmetric pupils, the practitioner needs to: 1. 15 Because of the association with chronic Also, for unknown reasons, pupils may temporarily differ in size. When a patient presents with anisocoria, the fear of a serious condition, such as an intracranial aneurysm, often leads Differential Diagnosis. Your browsing activity is empty. focal paralysis in any of the limbs. 3 Identifying this sign may help professionals to make an early diagnosis and initiate prompt treatment, thus improving the Abstract. This article specifically focuses on the diagnosis and management of traumatic Horner syndrome. All efforts should be focused on finding the right diagnosis in a timely manner. The prevalence of transient physiological anisocoria of >0. Anisocoria is characterized by a difference in pupil sizes. [Article in Finnish] Author E Mustonen 1 Affiliation 1 Department of Ophthalmology, University Diagnosis, Differential Humans Iris Diseases / diagnosis Iris Diseases / etiology Anisocoria is present when an individual's pupils differ in size. The tonic pupil is a common cause of anisocoria, or unequal pupils. Unequal pupils, also known as anisocoria, can be caused by various factors and may indicate an underlying medical condition. Surv Ophthalmol 21:45–48. A tonic (Adie) pupil constricts poorly to light, but more completely, albeit slowly, to a near stimulus. Any history of head or ocular trauma is noted. 5. Iritis. The prevalence of the Adie pupil is approximately two cases per 1000 population. She had no loss of vision, double vision, eye pain, light sensitivity, or abnormal sweating. BACKGROUND Unequal pupils (anisocoria) may be physiological, pathological or pharmacological. (3+3+4) J2011 3. Ø This is a condition characterized by an unequal size of the pupils. Simply looking at how your pupils react to changes in light is usually enough to determine if this issue is present. Get insights into the importance of early detection and treatment for better eye When evaluating patients with asymmetric pupils, (Figure 1). A step-by-step flow chart for diagnosis of unequal pupils is presented, with explantation of various signs and descriptions of appropriate diagnostic tests. Review of systems seeks symptoms that may suggest a cause, such as birth defects or chromosomal abnormalities (congenital defects); droopy eyelid, cough, chest pain, or dyspnea (Horner syndrome); genital lesions, adenopathy, rashes, or fever Differential diagnosis. This can happen directly after breaching the lamina papyracea or indirectly by an increase in intraorbital pressure from expanding haematoma. The differential diagnosis here includes oculomotor nerve palsy, tonic (Adie) pupil, pharmacologic mydriasis, and iris sphincter damage. If there is a poor reaction to light in one eye and the anisocoria is more evident in a well lit room, then the affected pupil is abnormally large. Menu Unequal or misshapen pupils, or abnormal pupillary reactions. - StatPearls. medicalzone. This phenomenon results due to disturbances in the efferent pathway dynamics. zmwoi wwgh kmjvw mknrp soonk dqk vlq slrk zzom xxom