OpenHealth Q&A

Persistent Uneven Pupils for Three Years Without a Diagnosis

Hello, I’m currently 19 years old, but this unusual issue began when I was 16, shortly after lockdown measures in early 2022. If my choices seem odd, that's the context behind it. I awoke one morning to find that my pupils were noticeably different in size—the left one appeared larger than the right. At first, I had no additional symptoms, so I went to my optician for an examination. Their tests revealed nothing unusual, and after taking some images and performing a visual field assessment, they referred me for an emergency CT scan at the hospital. However, I waited a lengthy two years only to discover that my referral had never been processed. I underwent another visual field test that yielded no comments, but I could tell that my peripheral vision had diminished significantly. Over those two years, I began to experience a severe throbbing headache on the right side behind my eye. Initially, I thought this was a result of wearing contact lenses that were drying my eyes, so I stopped using them. Nonetheless, the headaches recurred whenever I left my house. I informed the hospital about this development, and they expedited my appointment at the eye clinic. During that visit, the doctor suggested that my unequal pupils might have been a congenital condition that went unnoticed. I felt a strong urge to walk out at that point. He then speculated that I might have Adie’s pupil but asked me to return in six months for further examination. As those six months progressed, particularly towards the end, my headaches intensified. For context, in the sixteen years prior to this issue, I rarely suffered from headaches—so much so that I had previously found it hard to relate to those who often complained about them. Alongside the headaches, I began to experience additional symptoms, including dizziness, confusion, and coordination issues, leading me to stumble and occasionally walk into walls. My speech would also become jumbled during these episodes. These unsettling symptoms surfaced at the peak of the headache and typically faded within a couple of minutes; however, the headache itself would only subside after I managed to sleep it off. At my follow-up appointment, I was initially told that my pupils were not of different sizes—just an optical illusion. But after further examination, the doctor changed her mind. After conducting different tests and taking additional images, she indicated that my retinas appeared normal, and I was finally scheduled for a CT scan a month later. I had CT scans of my head, neck, and chest, both with and without contrast. I likely won’t receive my results until my upcoming appointment at the end of April, but I did request copies of the scans; from what I gleaned, they looked fairly normal. However, I must admit I’m not knowledgeable about the expected appearance of such scans, so take my assessment with a grain of caution. If anyone has insights into what might be causing my symptoms, I would greatly appreciate your input. I’d like to have some suggestions ready for my next consultation, so I can present them to my doctors when they express uncertainty regarding my condition.

Answers (1)

3/17/2025, 11:10:47 PM

OpenHealth AI

It sounds like you’ve been dealing with a very complex and concerning situation regarding your eye and neurological symptoms. Based on what you've shared, the uneven pupils and the associated headaches, dizziness, and coordination issues may suggest a few possible underlying conditions, but it's essential to await your scan results for a clearer picture.

Explanation

Unequal pupil size, known as anisocoria, can have various causes, including neurological issues, congenital differences, or even benign conditions like Adie’s pupil. The headaches, especially localized to one side, alongside dizziness and coordination problems, can indicate that there might be a neurological component that needs careful assessment. These symptoms have become more concerning given their recent intensity and the change in your health pattern.

Next Steps

1. Symptom Tracking: Continue to monitor and document your symptoms closely. Note the frequency, intensity, and context of your headaches, dizziness, and any episodes of confusion or coordination issues. This information can be valuable for your healthcare team.

2. Prepare for Your Next Appointment:

   • Bring a list of questions and concerns tied to your symptoms. Consider asking about:
     • The implications of the findings from your CT scans.
     • Possible neurological conditions linked to your symptoms (e.g., migraines, neurological disorders).
     • The relevance of unequal pupils and any further tests that may be necessary.
   • Share any incidents of your symptoms worsening or new symptoms emerging since your last visit.

3. Discuss Potential Referrals: If you feel your concerns are not being fully addressed, you can also inquire about being referred to a neurologist or a headache specialist for a more focused evaluation.

4. Self-Care Measures: While awaiting your follow-up, protect yourself from triggers:

   • Maintain a regular routine with plenty of hydration and sleep.
   • Minimize exposure to bright lights or screens that may trigger headaches.
   • Practice relaxation techniques (like mindfulness or gentle yoga) to help relieve stress and tension.

5. Education on CT Scan Results: It could be helpful to familiarize yourself with what is generally assessed in CT scans—this may help you engage more effectively with your doctors. For instance, they typically check for tumors, bleeding, or structural anomalies.

Your proactive stance in seeking answers is commendable. Maintaining open communication with your healthcare providers and ensuring your concerns are voiced will be crucial in navigating your ongoing health issues. If your symptoms worsen or you feel incapacitated, consider seeking immediate medical attention. Let me know if there's anything else you'd like to talk about!