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Uneven Pupils / Horner's?


kafie

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I was wondering if anyone else had any experience with this (since it can co-occur with Dysautonomia).

Horner's is when one (rarely both) pupil does not properly dilate in response to reduced light along with a droopy eyelid and lack of sweating (on the effected side). The lag-time on pupil dilation is 5-15 seconds, so it's hard to spot (there are similar stuff that changes pupil constriction as well). Near vision isn't effected (and will cause the pupil to dilate properly), and the ptosis doesn't effect looking up (in that the eyelid retracts properly). It may also involve flushing or redness in the face and eye on the effected side (which I have off and on).

When I first noticed it, I suspected cluster headaches (I do get really fierce headaches that fit the profile from time to time that nothing helps), but I'm seeing it even when I'm not having a headache. I guess swollen lymphs can press on the nerves or inflammation in the cervical spine (both are equally possible causes for me - I'm seeing an ENT soon to get my tonsils removed because they're a mess and I have symptomatic level 2 hyperplasia in all of my tonsils (palentine, adenoid, & lingual)) - but because there's connections to the basal ganglia and dysautonomia, I'm considering that maybe it's just the POTS?

The defect is in my left eye, same side that I've had ptosis for a couple years (it does get worse and better though) as well as a spider nevus and a lot of symptoms of mild vasculitis along with psoriasis, so I have considered that perhaps it's related to the psoriasis in my mouth and thus vascular in nature (I have some huge varicosities in my throat... it's so incredibly multifocal at this point that I can't even make sense of it).

On the bright side for me, this may explain why I have been experiencing poor night vision for the last year!

Anyone else experience anything like this? Thoughts? Advise?

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No, but MG would effect the eyelid's ability to retract (mine retracts just fine), at least to my understanding, so it's nothing like that. Since the ptosis has been present for awhile now it's far more likely that it's connected to something more benign for me (I seriously thought I was just tired but it's there all the time now).

I'd just love to know what it's from though. Feels like every couple of months there's something new and it's just bugging the heck out of me (my body could slow down, ya know)!

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Ugh. Yeah, probably. I'm seeing so many doctors now that... just... NOPE. I honestly don't have the energy to add another right now (it doesn't help that three of them I have to see every six months for blood work).

The last neurologist I saw found bilateral motor neuropathy through my ulnar nerve and suggested an MRI of my cervical spine but my rheumatologist didn't think it was necessary. *Shrugs*

If I ask for another referral my PCP just might explode at this point. (This is basically all my PCP does... well... and refill my antidepressant and prn nausea med)

I could probably ask my optometrist about it, but I don't know what that'll do me.

I guess this is the result of totally neglecting my health. 🙃

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4 hours ago, kafie said:

I could probably ask my optometrist about it, but I don't know what that'll do me.

That is a good idea - my optometrist refers patients to an ophthalmologist if he finds something suspicious . This might save you from making your PCP do too much …. lol. 

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Ophthalmologist, not optometrist. The eye place I went to has both, but I saw the opthalmologist, FWIW. They usually have experience in internal medicine and would be better than an optometrist. That said, I would bet it's nerve related, but why? If you see a neurologist, they should have a clue. 

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JimL, you're probably right. That one would probably go either to my immune system or whiplash from the car accident I was in last year.

I kinda figured at least an optometrist would have a rough knowledge of pathology effecting the eyes. I could have sworn that she added a note about the ptosis to my chart, but it seems to have been lost when they switched over their system a couple months ago (ironically, the note about bilateral carpal tunnel (which I do not have and I was told was going to be removed from my chart) is still there).

😅

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  • 2 years later...

Well old thread but i do have two uneven pupils also. When looking in the mirror the right is constricted (i assume because of the lighting) and the left is a bit dilated, it will constrict if i shine a flashlight in the eye but it is slow to constrict

Just wonder if this could be a issue with the sympathetic NS? or is it normal for a percentage of the population.

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