1. Examine Pupil Size
Your eye doctor will measure your pupil size in millimeters in both light and dark conditions. He will try to assess whether or not the pupils are significantly different in dilation from one another, a key indicator of anisocoria. Doctors may also use a technique called transillumination to gauge the differences in pupils more accurately. Other doctors may use handheld devices or gauges for further clarification.
2. Determine the Onset of the Condition
Doctors use an ophthalmoscopy lens to probe for anisocoria. A typical size for this lens is 20 diopters. Assuming the patient does not have any other visible symptoms, doctors can examine old photos or videos using special magnification techniques to determine when the problem started occurring.
3. Check Out Pupil Reactivity
Ophthalmologists use a reactivity scale from 0 to 4 to qualify how reactive a given pupil is. If the pupil does not react at all, it scores as a 0; if it is reacts briskly to stimuli, it scores a 4. If pupils react asymmetrically, this may be an indicator of anisocoria. Doctors are more interested in the differences in scores between pupils than they are in the scale of the scores.
4. Look for Features Associated Normally with Anisocoria
Pain in either the eye or intracranium can indicate anisocoria. This is often caused by an aneurysm or an otherwise compressed or abraded third nerve. If there is a lesion around the nerve that is causing the physical symptoms, proptosis may present. In a case where anisocoria is related to third nerve palsy, your ophthalmologist may detect two other symptoms, Diplopia and Ptosis. Given that the causes of anisocoria can be many and can range in severity from completely benign to life threatening, it is important to get your diagnosis done by a trained medical professional.
