Question:
I posted earlier but it didn't seem to go through. To repeat, I had an
hour long eye exam today after four months of what seemed to be
iritis. I was diagnosed with dry eye. I had been having small pupil
size, but this morning the right pupil was smaller than the left till
I got out in the sunlight. They did not notice any difference at the
office. Tonight, the right pupil is once again smaller! Does anyone
know if this could be normal? One website did say this can sometimes
happen.


Answer:
Hey Tom, how are you doing? Medical care of patients with
anisocoria is entirely dependent upon the etiology. Anisocoria, or
difference in pupil size, is a common condition. Depending upon the
origin of the anisocoria, consultation may be useful. If other family
members also have this condition, then pupil size is probably genetic
and is nothing to worry about. Head injuries that cause differing
pupil sizes are usually curable with early recognition of danger signs
and medical treatment. If there are no other symptoms and if the
pupils return to normal, then the transient condition is nothing to
worry about. Several drops are used in diagnosis of anisocoria
(Cocaine 4-10% ophthalmic solution, Pilocarpine (Isopto), and
Hydroxyamphetamine 1% (Paredrine)). After treatment, resume normal
activities, but avoid fatigue. A low-salt diet is recommended. Best
wishes,


Answer:
First, thank you so much for your response. I have no idea if this
runs in my family. They dilated my eyes at the eye clinic, it took 15
minutes and left me with blurry vision but they saw no problems. In
the last two days my pupils have been fairly small, sometimes their
normal size, but even except for maybe one time. Then this morning,
the right one is again smaller than the left. I have two "gum boils"
not far from my nostrils and have wondered if this might be involved.
I recently had extensive blood tests for a back injury and was told
that I am in excellent condition. The eye doctors found only dry eye.
I have had a twitchy right eye for months or years, not bad and only
occasional. Not the sort of twitching that is "up and down" movement.
(But it is the eye, not just the lid.) One time the other night after
the eye appointment, the LEFT pupil actually was smaller than the
right. Then for two days, normal pupils. I have had smaller looking
pupils for about four months. Extensive eye tests showed nothing. If I
mention a check for the gum boils, which are decidedly real, before I
see a dentist (I have to wait a few weeks or a month more on that),
the doctors will probably say it's nothing, and they will think I'm
panicking if I ask for more extensive testing like an MRI. I have
severe anxiety to begin with. I have never noticed a pupil smaller
than the other, and I rarely have "smaller" pupils as I've had many
times in the last few months. I would like to add one quick thing --
the first time I noticed the pupil change was after I used a new kind
of eyedrops, Visine for itchy eyes or somesuch, not regular Visine.
Then, after using the eyedrops they gave me at the clinic, I had the
smaller pupil(s) again. Last night I used quite a bit of them before
waking up this morning to find the right pupil slightly smaller. Thank
you again for the response. It was good to know that pupil size
variations are common.


Answer:
Tom, the condition you are experiencing can be directly associated
with your gum boils. You need to be on an antibiotic. Your eyes should
return to normal within 6-8 weeks. A blood test would be a smart thing
to have as well.


Answer:
Thank you for your response. I have had blood tests recently showing
no infection of any kind, though the boils would be localized, I
realize. Outside of a root canal, how can I have these treated? I had
been on antibiotics for a while. Reading about eye twitches and things
like that, I'm finding disturbing information about brain cancer and
the like. A friend of mine who worked with a dentist has told me I
could sterilize a needle to drain the boils, which are just above the
gums on either side. I am having financial problems but do intend to
see a dentist. The internist I've seen is not going to believe this is
cancer from my blood work. I don't know what his opinion of gum boils
would be. What could I do as quickly as possible about this? You don't
seem to think I should ask for an MRI.


Answer:
I would also like to ask, if they keep finding nothing in blood work,
which was very, very extensive, I'm told, what is it you in particular
are thinking of when you say I should have blood work, if you don't
mind my asking?


Answer:
The reason I don't think that you need an MRI at this point is because
you don't mention any symptoms associated with your pupil condition
other than the change in size and the eye twitching. If you are having
problems with high blood pressure, balance problems, headaches,
dizziness, any problems with your vision, weakness -
numbness-tingling-pain in your arms or neck, then a Head CT, MRI or
MRA would be in order. If your blood work up was truly extensive, then
your doctor would have included a sedimentation rate in his order as
well as a CEA. The sed rate would show whether or not an inflammation
process is occurring in your body. A CEA is used as a tumor marker and
can detect cancers. And, a CBC would show whether or not your WBC
(white blood count) level is normal or not. A high value would
indicate an abnormality. I don't think you have a brain cancer. If
I were you, I would NOT treat my own gum boils. If you don't aspirate
it properly then you might end up with more problems than ever. Please
see a dentist to help you with that and to advise you of treatment.


Answer:
I really appreciate this response. Unless a benign tumor might be the
case, I was told cancer was ruled out completely in the blood tests,
which did cover what you mentioned. The only thing I left out was that
my vision has seemed somewhat weaker in recent months. I went for two
months without glasses in late 2004, then got a new pair which was "a
slightly different prescription," the new people told me. I am
extremely nearsighted. I explained the seemingly weaker vision to the
eye doctor I saw last week. It improved the first day after I used the
eye drops I was given, but it is back to being somewhat dim without
the glasses. It could be my regular eye condition, after the months
without glasses, then the new glasses. It is worse in my right eye
(the one with the on-off smaller pupil) but my right eye has been my
"bad" eye since I first started wearing glasses in 1982. As I told the
people the other day, it just seems bright light is brighter and
things are just somehow a bit dimmer, like words on my computer screen
for instance. I would not call it a "blur." I said occasionally it's
kind of a "wet" look to things. I would say it is weaker vision than I
had in late 2004 when I went without glasses. Still, I go without
glasses and adapt to it because until 1996 I never regularly wore my
glasses. Wearing my glasses now, my vision is about as good as it will
be, and this is what the eye doctor I saw was concentrating on. So
that's what it comes down to, besides the pupil changes -- since Jan.
I had been noticing a glare to things now and then, had some red eye.
They found no iritis, cataracts, glaucoma, not even early stages. I
had just had the weaker vision and the smaller pupils which I did not
pay attention to. My suspicion became iritis eventually because of the
pupils being smaller and the sore, red eyes. The eye doctor said the
sharp pain the left eye (especially, but not overwhelming) and the red
eyes were from dry eye. The tests lasted about an hour and no
indication of eye disease was found. I am making plans now to see a
dentist, even if the gum boils weren't involved in this, I want to get
them resolved. In the middle of my dealing with all this, the doctors
had been running the blood tests partly because of a sore rib pain
which they have finally decided is a pinched nerve (yes, with the eyes
I had suspected ankylosing spondylitis, but it's apparently been ruled
out). My white blood cell counts in three overall tests, two being the
extensive ones, were normal -- all of it "perfect" in the words of
doctors and nurses. My thyroid was checked (TSH) and I was tested for
inflammation (muscle inflammation specifically in the final blood
test). No infections, nothing. The internal medicine doctor said he'd
check my thyroid a few months from now. (I take lithium.) Going by
what they said and what you said, and my overall healthy feeling
outside of my rib area soreness, I don't really suspect cancer, unless
it was something like a benign tumor beginning to impede on my vision.
I don't know if bloodwork would hint at something like that or not. In
summary, I am long-winded (I know) and I thank you very, very much for
taking the time to give me advice. Until I can get antibiotics
prescribed--which may be a week and a half from now--I will take some
leftover Allegra I have. I have not taken antibiotics since Jan. or
Feb. The eye doctor and his nurse said they "saw indications of
allergy," and I used to have bad sinus problems that somehow got
better over the years. Thank you again for your responses, this site
is extremely useful, interesting and helpful!


Answer:
I want to mention one last thing. In late Jan. I had a great bout of
anxiety over problems in the life of a loved one, and I've been
dealing with grief for a long time over the loss of my parents. Our
family home was sold in Dec. and by late Jan. my emotions were just
reopened horribly. In Feb. and March I had a lot of episodes of
fatigue and weakness which were part of what I got the blood tests and
physical for. I have not had this fatigue in at least two weeks though
I do get sore from the rib area pain I mentioned. My cousin has
fibromyalgia and is convinced I have it too, and I've heard it may
affect eyes. But, if the fatigue were cancer related, it has not been
all that consistent, and the bloodwork showed nothing as I said. My
hands will be sore some days, then almost normal on others. The doctor
did write "myalgia" on my symptom list. The fatigue was not a feeling
of tiredness, it was a restless and weak feeling that is hard to
describe. My regular doctor said it was anxiety. Because of its coming
and going, and now not being here since my mind has been off of it for
awhile, that "feels" right. (I had a bout with psychosomatic pain when
I was much younger, but not bodily/muscle pain, it was "irritable
heart.") I was not sure the rib soreness and back aches with it were
even related to this fatigue that appeared mostly in Feb. and March.
So that is my whole story on this. If I were to request an MRI the
internal medicine doctor will definitely say he doesn't feel it's
necessary. The gum boils will be evident when a dentist looks at me. I
apologize for all the long-windedness, your words are very much
appreciated.


Answer:
Tom, When your doctor wrote "myalgia" as your diagnosis, that simply
means pain in the muscles - it's very non-specific due to him not
having a specific diagnosis. I don't think you have fibromyalgia. I
think you legitimately have a lot that you are dealing with in your
life and that the stress and anxiety of it all are taking a toll on
you physically and emotionally. I have some suggestions for you.
First, are you seeing a councilor? If you aren't, then you really
should - there's nothing shameful about that and it would be good for
you - even short term. You need to talk to someone about all of these
feelings and problems you are having since they are so very
overwhelming. And if you are already seeing one and have been for some
time and are not feeling better, you might consider seeing a new one
to gain a fresh and new perspective. Secondly, you have a lot
built up inside of you and the mind is a very powerful thing. If you
can, get out and get some exercise. Walking would be great for you.
Getting involved in a sport or some other type of activity would be
great for you, too. Physical exercise can help release stressors in a
tremendous way! And thirdly, you are afraid that you might have a
tumor of some sort. Because you have been dealing with this eye
problem for some time now and you have other symptoms, I would call my
doctor and tell them you would like an MRI ordered. This would not
only help to ease your mind by putting an end to your wondering, but
it would also give you an answer to your fears. It's expensive (I
don't know what kind of insurance you have) but if you do have
insurance, it would be covered as long as you mention these other
symptoms. Because you have a variety of medical problems that come and
go, your doctor has possibly been hesitant about ordering the MRI but
don't be concerned what the he thinks of you for asking for this. He
isn't the one having the problem and because it is persisting when all
other things have been ruled out, he should be willing to order this
for you. It is a good study that evaluates the structure of the entire
brain as well as its vasularity. Call your doctor's office tomorrow
and ask for his nurse. Tell her that you are having continued (and
mention any new) problems with your vision etc and tell her to ask the
doctor for an order for the MRI. She should be able to call you back
with an answer within one or two days. You'll feel better about this
whole matter if you have this done.


Answer:
Thank you for your response, again. Not having found any sign of
malignancy, the doctor may try to back out of an MRI, but I will
pursue it. Stress may have been the reason for the bouts of fatigue.
Brain abscess and brain tumor have been my two main worries here,
since I put the vision with the muscle aches. The smaller pupil size
at times might be the one thing that will make them consider doing
this, though this doesn't occur much when I'm out in the sun, and
seems to happen mostly in the morning or late afternoon, and happened
somewhat at night. As far as I know, that only began about five days
ago, and for most of that time has not occurred. Just the smaller
pupils in general, with normal sized ones at other times. If there is
no brain abscess or tumor, the gum boils (it may only be one boil, I
am not sure if the left-sided one is even "there") -- which may be
fistulas -- being the cause of this, is still a mystery to me as to
how that might work. The internal doctor may tell me first thing that
that is the problem in his opinion and to get to the dentist. I will
see what he says, unfortunately he is the only doctor in the entire
area who will set up quick appointments. He will probably consider
this hypochondria. I have Medicare and Medicaid. Thank you for your
response. If I had a malignant tumor for five months and pain dating
back nearly a full year, it would seem the cancer would be showing.
I'm dealing with a situation hard to explain!


Answer:
I would like to add one more thing. I just talked to a family friend
who had a brain aneurysm in the early 90s. She knows my bloodwork has
been normal, etc. She says there is "no way" they are going to run an
MRI on me. I told her the pupil size might be a reason to get them to
(if they see it, and so far I haven't had a chance to take a photo),
but she said she does not think it will happen. They "might" give me a
CAT scan, she said. As you can see, I am not so much thinking
malignant tumor as possibly something benign (because of the
bloodwork). I have no idea if a tumor is even involved. I've had RLS
symptoms for years, then last year some inner rib pain that eventually
hurt where I could touch it under my right rib. I had asked an ER
doctor in Feb. what he thought about brain abscess (because of the gum
boil(s)) and he said "no." I have no overt signs of that or brain
tumor, as far as the usual things mentioned as main symptoms, or that
people go to the ER for. I thought of going to the ER today but my
neighbor doesn't even think the internal specialist will order an MRI.
I have no idea how long a brain tumor, benign or malignant, might be
present, or how it might manifest as symptoms. I can just hear the
doctors right now telling me that my symptoms are not extreme enough
to be a brain tumor or abscess. I stay active and have been sleeping
much better, possibly the reason the muscle aches are so much better
(though one day walking quite a distance I had them pretty bad one
night). Some of what was stressing me is now off my mind. For all I
know, stress might affect vision. I got a new pair of glasses in Dec
after going without glasses for nearsightedness, and it was four days
later that I noticed a glare from my computer, and then the visual
changes later with the smaller pupils this year. So I am just saying,
they may not do an MRI, and if they won't, I will be left wondering
what this is. If it is NOT serious, then it may stay the same and I'll
be wondering for months to come! [b:54c90a7c74]I was wondering if you
were thinking brain abscess when you mentioned the MRI. If it were
brain abscess, I'm not having most of the severe symptoms and have had
it for some time apparently. Outside of a benign tumor of some sort I
can't see how this could be cancer.[/b:54c90a7c74]


Answer:
Tom, Did any of your doctors ever witness the problem you are
saying you have (when one pupil is smaller than the other)? I was
under the impression that they had. Personally, I do not think you
have a brain abscess or a brain tumor - benign or malignant. Whether
or not your doctor will order an MRI will be determined (I'm sure) on
whether or not there are sufficient symptoms for a payable, proper
diagnosis. If a doctor has never ever examined you while you were in
the state where your pupil size was different in each eye and you are
otherwise complaining only of dry eyes, redness, intermittent blurred
vision and glare and gum boil(s), then they very well may refuse to
order anything further at this point. The doctor would have to
actually witness teh pupil-size change. And no, I don't think you
should go to the E/R or are in any emergency situation at all. I'm
saying you should ask for the MRI because you are obsessing about this
whole matter and the only way I think you are going to be able to get
beyond it is to have the study done. When I read back from your
beginning post to the present, your words are contradicting your
condition.


Answer:
No, the pupils dilated properly at the eye exam on the morning I first
noticed the change in pupil size. Only myself and my neighbor have
seen the change in the pupils. The right one is quite small many times
and the left one will be just a bit smaller, then they will be the
same small size, or return to a normal size that is even. On one
occasion, the left pupil was smaller. [b:8f51227bfa]My neighbor
noticed the size change in the right pupil. [/b:8f51227bfa] We are
both a bit mystified by it. I am aware there are no strong indications
of brain tumor or abscess. My guess is that if anything is wrong it
relates to the increasingly sore tooth abscess on the right side high
on the gum. I was, however, disappointed to read today that the tumor
marker test will not usually point out brain cancers. My white blood
cell count and other indicators have been "perfect," in the words of
the people who've read the tests. If as you originally said, a gum
boil might affect the pupil (I read that a "sinus cavity fistula" can
do so), that may be the whole problem. I have reason to believe the
rib pain is indeed a pinched nerve problem from heavy lifting and a
hard fall last year. I need to find out what the gum
boil/fistula/abscess might be causing pupil-wise; if it has not spread
to become a brain abscess and might still be causing the pupil problem
or even affecting vision, I need information and a diagnosis on that.
In spite of days of use of eye drops, I still have sore red eyes, and
the doctor seemed to suggest the weakened vision might be related to
having had "dry eye" for some time. I just wanted to clear it up that
the pupil change has been dramatic a few times, and simply obvious at
others, and most of the time the pupils are even. This has only been
noticeable for five days. When I first saw it I was brushing my teeth.
I can't explain it and I don't know how it figures into the rest. But
your advice is appreciated. I wanted to ask specifically if there
might be a reason you suspected tumor/abscess causing the
vision/bodily soreness. The pupil size during the eye dilation at the
eye doctor visit was normal. At least some of the time, I read, a
problem with a pupil that has gone down in size will cause this pupil
not to dilate in these tests. So what is causing it, I don't know.
I've wondered if the newer eyedrops I had bought six days ago, then
the ones I was given at the eye clinic, could have been involved (some
sites say eyedrops will cause pupil size variations). The thyroid test
that made the internal doctor call me back for further blood work
showed a .04 (not .4) thyroid reading, with hyperthyroidisim being a
possibility, then I had a .5 normal reading with the T3 and T4 being
normal. So I had already wondered if a pituitary adenoma might be
involved, but I had not put all of this together. Right now the
doctors will probably stick with saying I am healthy. Looking up the
brain tumor information today, I recalled reading about pituitary
adenoma, and that got me wondering if it might have caused a sudden
change in the thyroid level that was reversed. I have the feeling I
will be told by my regular doctor that is unlikely. (He believes the
.04 reading was a mistake at the hospital lab, though the nurse there
said the thyroid reading could change that dramatically.) Yes, this
is obsessing, but logically I don't know if there is reason enough to
request an MRI. The pupil changes, whatever is causing them, may be
the only thing "odd" enough to make me be overly concerned right now.
On some websites showing illustrations of "pupil size difference," the
sizes they show are [u:8f51227bfa]less[/u:8f51227bfa] disproportionate
than mine have been a few times, and fairly equal to the difference.
The right pupil just looks small, but returns to normal sizes.
Thank you.


Answer:
Just one final note -- the pupil size variation came from out of the
blue, I had no idea if it was a problem or not, just that the first
time I noticed it, it was strikingly odd. It has been observed by a
neighbor of mine. The first night of the morning I first noticed it,
the pupil size seemed to change as I was cleaning my bathroom, bending
and stooping. That was when the left pupil briefly was smaller than
the right. Today, the right pupil is again somewhat smaller than the
left many times when I check. There have been no "huge" differences in
size like I noticed the first day. I have no idea what this is! It's
real, someone else has seen it, and I did not mean to contradict
myself in any way here -- I am writing this all quickly and wanted
your opinions. (Or those of anyone caring to respond.) THE LAST THING
I WANT IS AN MRI!!!! I AM NOT TRYING TO OBSESS MYSELF INTO OBLIVION
WITH THIS. The pupil size just seemed ominous compared to what has
already been treated, after I read about pupil size variations. If the
gum boil could be affecting me, that might explain the whole thing. I
was told by the eye doctor that he did not believe that the abscess or
abscesses would affect my eye (obviously he meant unless they spread
to form brain abscesses). That was it -- I can't think of anything I
left out, I even mentioned the RLS-like symptoms which my former
doctor has found strange for years, but which have yielded no abnormal
results in blood tests. I thank you once again for your time, God
bless.


Answer:
To answer your specific question about why I thought your eye problems
might be related to your gum boil is because you had or have several
symptoms of Iritis and in many cases, Iritis is related to an
infection in another part of the body. Good luck Tom, I know you are
very worried about all of this. I hope you are able to find an answer
soon.