One smaller pupil 5mo

[adrie]

Hello everyone,

On Tuesday, I noticed that one of our son's pupils is smaller. It has been consistently smaller ever since. It's more noticeable in dim or dark lighting but you have to be so close to his face to see it. I looked through old photos and we have one where it seems the most obvious this likely has been present since birth.

Anyways, I made an appointment with the same ophthalmologist clinic we had our daughter's eyes checked at 6mo, and when we went there, the doctor stated he may just still be growing, and it could even out. She stated that he was tracking really well, and his eyes were positioned correctly and moving in sinc with each other. Over all, no grave reg flags as far as she mentioned.

I mentioned concern about Horner's Syndrome, and she stated that Horner's typically presents with diabetes. ?? The only info I have found with this in in relation to cats and dogs, and perhaps much older people who later acquired Horner's.

Regardless, we actually have Type 1 on my spouse's side of the family (one of his brothers, and two cousins).

She provided me a referral for a pediatric ophthalmologist to "rule" anything out such as Horner's, and stated I will likely have to wait about 3mo to be seen. She also requested I follow up with her in 6mo.


Just wondering if anyone has any input in all of this. I have linked a picture; he was 3 weeks old at the time, and you can tell there was a difference in size even then.

 

[_Meep_]

Hey,

My older daughter has had this since, well, as long as I can remember. I didn't notice it from birth, but she was born in the summer and very sleepy so the only times her eyes were open, it was generally in bright light so both pupils were pinpricks. It's only really noticeable in dim light when her pupils dilate. I didn't notice it until she was several months old.

Of course, I freaked out and did loads of Googling and convinced myself she had Horner's. She actually had an opthalmology appointment as a little baby because one of her pupils kept showing up white in photos which can be a sign of a rare cancer! She didn't have it thankfully - but they didn't say anything about her pupils being different sizes then either. Cue me freaking out even more that it was a 'new' thing - but probably it just wasn't a big deal.

I've sort of just come to terms with it now she is 3 and has shown no sign of vision problems whatsoever. In fact, it's a lot less noticeable now. As far as I understand it, as long as the difference in size is less than 1 mm, it's highly unlikely to be anything sinister. And as long as the pupil still dilates properly, it's incredibly unlikely to be Horner's. A Horner's pupil stays very small, even in the dark.

As far as I'm aware, in children at least, it's from damage to a nerve or a growth pressing on a nerve - NOT trying to scare you, it's highly unlikely your baby has either of these problems - I'm just saying I don't think it is just caused by diabetes. Not that I'm a doctor!

What he most likely has is completely benign anisocoria which like 20% of the population has to some degree. Check out your own eyes and your partner's - most people are completely unaware they have it, and it could be he has inherited it from one of you. In our case, a cousin of mine has it. And actually, my grandpa had Horner's following a viral infection in the 80s and was totally fine, so it's not always a dreadful thing.

 

[adrie]

Thank you so much for your reply.

All of our eyes look even, but then, maybe there could be a slight variance that is hard to be detected by sight alone.

I'm awful at math and I'm not sure if the variance of his pupils 1mm or less; the ophthalmologist never mentioned the size difference and I didn't ask. I've read there can be a variance of up to 2mm, it all depends where you look I guess.

When you say with Horner's, that the pupil stays small, do you mean it does not really dilate in various sources of dark and dimness? Kye's smaller pupil dilates but not nearly as large as the other one. I've also noticed that it dilates/constricts at the same rate as his other pupil, just obviously not as large in dim/dark lighting.

I honestly don't think there is anything super serious/life threatening, and even more so as the ophthalmologist did not place an urgent or emergent referral. I have a doctor's visit scheduled next week and hopefully the paperwork from the eye doctor has been faxed as I requested.

 

[_Meep_]

Yes, it doesn't dilate much at all in dim light, and certainly not at a normal rate/similar rate to the other eye. My daughter's smaller pupil is exactly the same in tendency as you describe and she definitely doesn't have Horner's. Also, it has really improved as she has grown. It didn't even look perfectly round or central sometimes when it dilated, which terrified me at the time, but it seems to have sorted itself out now and is round and the size difference is minimal.

I think all will be well with your son.

 

[adrie]

Thank you so much! I'm sure she is beautiful; honestly, I think a bit of a smaller pupil is neat and a unique thing to have

 

[erinprime]

I made the same post when my now 3.5 year old was 2 months old. I am sure you can search for my old post if you want to see a picture, but her pupils were drastically different sizes. We got it checked out by an opthamplogist (and even had a follow up a year later just to completely ease my fears). She has no problems with her eyes or vision at all, it is just a quirk in her appearance.

I worried a whole bunch for no reason. I hope your story ends the same.

 

[_Meep_]

^ Haha! I actually commented on this post over a year ago asking for updates.

 

[_Meep_]

Lol, I just took this. It's still there, but definitely not as radical as it was!

 

[adrie]

I noticed that in previous posts you both mentioned that the size variance wasn't always present with their pupils...does that mean that in dim or dark lighting they sometimes are/were the same size?

My son's pupils are not the same size unless exposed to light at this age so far.

 

[adrie]

Hey Meep, that current picture is basically the size variance of my son's pupils.

 

[_Meep_]

In dim light, when she was younger, they were never the same size. In bright light, always the same size. Now, it varies. Sometimes it is more noticeable, sometimes I can barely see a difference!

 

[adrie]

Hi Meep...I just noticed your other reply about your daughter seeming to have a weaker side at a young age that evened out...

I've been noticing my son seems to favour his left hand as well (regular pupil). He still uses his right hand, reaches and can hold and bat toys, puts each hand separately or together in his mouth, with or without toys; brings both hands to mid-line; puts one or both hands to his bottle, etc., he just seems a bit more dominant on the left side. He rolls both ways and can scoot around, and has been doing so and bearing weight for 1.5 months now pretty much. He is starting to learn to sit while bearing weight on his hands for support. He was 5mo on July 21.

I just had a check up with the GP yesterday and he did not seem concerned.

I'm wondering, was your daughter's smaller pupil also on the right side? I am worried about CP, and the funny thing is, I actually have mild CP on my entire right side. I guess like any mom, I wouldn't want any sort of diagnosis for my child. I know what it's like to have this disability, and though I compensate just fine, it annoys me from time to time; probably because I have a totally normally functioning side so I'm more aware of the variance. I'm fairly certain though that I did not use my right hand like my son does his own.

 

[_Meep_]

Hi,

Yes it is her right eye! How interesting your son has some quirks too. The eye was another thing actually that worried me with regard to CP, as ALL her 'problems' seemed to be on her right side. When I say problems, though, she didn't really have any - just the smaller, irregularly shaped pupil, a weaker right hand which she fisted, rolling to the left all the time (though she could roll right), teething on the left side first with EVERY pair of teeth that came through, a right foot that turned in a little bit ... even recently, in the last six months or so, I discovered that she could stick her tongue out to the left but not to the right! Man did I freak out.

ALL of those problems resolved on their own though. Every single one. Though for the tongue, it took two applications of chocolate mousse on the right corner of her mouth before she miraculously learned how to do it.

She is a completely normal, healthy, typical, active, agile, fantastic little girl. Her manual dexterity is brilliant, she's been on time with all her milestones, her speech is beyond her years. There is nothing wrong with her at all and I know that now, but it took a long time to accept it.

I still don't really know what caused it all. She got a bit stuck while she was being born and had some treatment for a sore neck and spine as a baby, so maybe that left a mild injury that took some time to heal. She also sucks her right thumb and has since she was tiny, so maybe that meant her right hand got less practice. I used to feed her lying down in bed all the time on her right side, leaving her left arm free to wave and fiddle about. That was another of my theories.

Your son honestly sounds normal. I actually saw a physio just after LO started walking as I was so panicked and even with all this shit going on and the fisting of the hand while she trotted about, the physio assured me she absolutely did not have CP. So if it really starts to get to you, which I totally understand, it's a good route to go down.

I think, though, because of your own condition (and for me, because of my stupid anxiety), we just notice these things more than other people would and possibly blow them somewhat out of proportion.

 

[adrie]

Hi Meep! I somehow forgot to reply...thank you so much for your huge post in response

In all honesty, I am no longer concerned about my son having CP--he often uses his hand more than I use my own, and I'm grown.. And his gross and fine motor movements are developing more and more. If he had CP more time wouldn't even out his hand/fingers in terms of development, but make it more noticeable as the normal hand developed on time. Like you, I am SUPER detail-oriented, verging on neurotic really. It drives me mad and something I'm working on as it starts to work against me.

Much like your daughter, he is on time/advanced in his milestones, particularly in regards to physical strength and mobility. He is rocking back and forth and often bears all of his weight on his hands and tips of his toes...not even 6months and I think he will full-on crawl any time now!

We still have a pediatric neurologist appointment booked for Aug. 22 which I am keeping of course--it's a 2hr appt. apparently! Just to make sure there isn't anything wrong, hopefully. My instincts say he is perfectly healthy.