Date of last review: Due to be updated

Differential diagnosis

  • Small pupil
    • Essential anisocoria
    • Adie’s pupil
    • Tadpole pupil (migraine variant)
  • Ptosis
    • Involutional ptosis
    • Myasthenia

Possible management by Optometrist

Treatment

  • None

Advice

  • Further investigation may be required, although, in the absence of other signs or pain, an underlying cause is often not found
  • Surgery may be considered for ptosis, particularly if visually symptomatic

Management Category

  • Refer to ophthalmology
    • Urgent referral if acute presentation
    • Routine referral

Possible management by Ophthalmologist

  • Neuroimaging
  • Aspirin for 12 months, if carotid artery dissection confirmed
  • Surgery for ptosis