Anisocoria

A Difference In The Pupil Size Of

The Either Eye
Causes of anisocoria
1. Posterior synechiae from trauma or
inflammation
2. Accomodation defective (
accomodative convergence spasm)
3. Failure to parasympathetic
innervation
4. Drugs
Symptoms of anisocoria
• Headache
• Blurred and double vision
• Loss of vision
• Fever, nausea, vomiting
• Eye pain and irritation when exposed to
light
 CONDIITONS
MYDRIASIS MIOSIS
Visual acuity may be blurred An increased depth of focus
and decreased when may be noticed with
pupil is mydriasis. miosis
Treatment Of Anisocoria

• Determine what has caused the condition.

• Diagnosing and repairing the mechanical
damage of the iris.
• Treating the oculomotor nerve palsy.
 Aniseikonia
Visual defect in which the shape and size of
an ocular image differ in the two eyes
 History of aniseikonia
• Donders (1800’s) first recognized the
theoretical possibility of image size difference
• But it was the Dartmouth eye institute in the
1920’s and 1930’s that studied 10% of the
population of Hanover,NH.
• Clinically significant aniseikonia was found in
3% of this population.
Symptoms Of Aniseikonia
 Aetiology
• Optical aniseikonia: it may occur due to
inheritant or acquired anisometropia of high
degree
• Retinal aniseikonia: may occur due to :
1. displacement of retinal elements towards the
nodal point
2. stretching or edema of the retina
Clinical Types Of Aniseikonia
1 Symmetrical aniseikonia
I. Spherical: image may be magnified or
minified equally in both directions.
II. Cylindrical: image may be magnified or
minified symmetrically in one meridian.
2. Asymmetrical aniseikonia:
• Prismatic : image difference increases progressively
in one direction.
• Pincushion: image distortion increases progressively
in both direction as seen with high plus correction in
aphakia.
• Barrel distortion: image distortion decreases
progressively in both directions as seen with high
minus correction.
 Measurement of
degree of aniseikonia
Space Eikonometer: The
degree of aniseikonia can be
exactly measured with the
help of eikonometer . It is
expensive and heavy and of
little therapeutic value ,
therefore in practice it is not
used anymore.
 Rough Estimate Method
• Rule of thumb given by Dartmouth studies
• If the difference in image size associated with
anisometropia primarily of refractive origin,
the aniseikonia produced will be about 1.5%
per dioptre of anisometropia
• If the anisometropia may be axial .an estimate
of 1.0% per diopter is more useful.
 Signs of aniseikonia
1. Aphakia
2. Anisometropia
3. Low steropsis
4. Strabismus
5. Amblyopia
6. Astigmatism
 Analysis Of Aniseikonia
1. Spectacle prescription
2. Keratometer
3. A-scan
4. IOL status.
 Clinical features
• It usually occurs when the difference in size of
images is between 0.75% to 5.0%.
• Meriodonal distortion are more poorly
tolerated , especially when they are oblique.
• While walking , the ground appears tilted and
patient may feel as if he is walking on hill.
• Squares appears as rectangles.
• Circles as ellipses.
• Amblyopia frequently occurs with neurologic
aniseikonia
• Strabismus frequently occurs with
physiological aniseikonia
Treatment of aniseikonia
1. Optical aniseikonia
• Contact lens are better choice than
spectacles for correcting anisometropia
aniseikonia.( image size diff. 5 -7 %)
• Unilateral aphakia is best corrected by IOL.
• Glasses : image size difference 30_33%
Treatment of aniseikonia
2. retinal aniseikonia: it is corrected by
treating the causative disease
3. Cortical aniseikonia: it is very difficult to
treat.
4. Isokonic glasses: it works on the principle
of angular magnification, without adding
refractive power it magnifies the image.
ANISOMETROPIA
Anisometropia
A difference in the refractive error
between the right and left eye.
 Types
1. Simple Anisometropic Eye - Under this
condition, where one eye get impacted while the
other eye tends to be normal. It is also called simple
myopic or simple hypermetropic.
2. Compound Anisometropic Eye - This is the case
where in both the eyes are in the state of myopic but
with a notable difference in the refractive power.
3. Mixed Anisometropic Eye – This is the last stage
wherein both eyes have refractive errors. Also, one
eye is hypropic whereas the second eye is myopic.
Symptoms of anisometropia
1. Headaches
2. Eye strain
3. Light-sensitivity
4. Complexity in reading
5. Nausea
6. Double vision
7. Faintness
8. Tiredness
9. Impaired depth perception
 causes
1. Inborn defects in the eye
2. Uneven growth in both eyes
3. Miscalculation of intraocular lens power
during the cataract surgery.
4. Surgical and non surgical trauma and
diseases
5. Unequal demand on ocular accomodation
between the right and the left eyes
 Condition (vision in anisometropia

1. Binocular vision:0.25D difference

between two eyes cause 0.5% difference
between two retinal images , and 5% of
retinal image difference tolerable i.e. 2.50D.
2. Exclusively uniocular: if one eye is high
refractive error and vision is not good in early
stage of life . Better eye is alone use and
amblyopia is produced
3. Alternate vision : each of two eyes is
used one at a time , usually occurs when
both eyes have good visual acuity.
• One eye is emmetropic and other is
hypermetropia or myopia
• Myopic eye is use for near vision and
hypermetropic for distance vision
• In this condition patient may be comfortable
Side Effects of Anisometropia
1. Amblyopia
2. Exophoria / exotropia in children
3. Esophoria / Esotropia in adult
4. Aniseikonia
5. Disruption of binocular single vision.
 Management
1. IN CHILDREN:
• In children under the age
of 12 full correction is
worn.
• If this condition becomes
severe, use of an eye
patch may be prescribed
2.In adults
• The weaker refractive error should be full
corrected and higher refractive error under
corrected.
• In elder patients correction involves headache
and dizziness, so that some compromise will
be necessary.
• In adults with alternating vision , the condition
usually best left alone and no need of
correction is required.
 Treatment
1. Spectacles
2. Contact
lenses
3. IOL implant
in aphakia