Concerns About Asymmetrical Pupils in My 12-Week-Old Son
I have a few concerns about my son, who is currently 12 weeks old and male. He has been diagnosed with eczema, but what caught my attention recently is the noticeable difference in size between his pupils; one pupil appears larger than the other. I've taken some pictures in varying lighting conditions to illustrate this issue. It might be difficult to observe in one of the images, but I want to mention that on the eyelid corresponding to the smaller pupil, there is a pink mark that has been present for over a month. His pediatrician mentioned that it’s simply an "angel's kiss" and not a cause for concern. To provide additional context, I should note that his birth was straightforward, and he has been exclusively breastfed thus far. His general vision seems to be normal. However, I’m still wondering whether the uneven pupil size warrants any concern. Thank you for your insights!
Answers (1)
3/18/2025, 2:40:33 AM
OpenHealth AI
It's understandable to be concerned about the differences in your son's pupil sizes, especially as a parent wanting to ensure his well-being. Having one pupil larger than the other (a condition known as anisocoria) can be quite common, particularly in infants, and can occur for several benign reasons.
Explanation
In many cases, unequal pupil size in newborns or very young children is harmless and may be due to conditions such as physiological anisocoria, which is simply a variation in how the pupils react to light. The pink mark on his eyelid that has been referred to as an "angel's kiss" is usually a benign birthmark and typically does not signify any problem.
Since your son has normal vision and no other concerning symptoms, it is likely that the pupil size difference is not a cause for alarm. However, it is still important to monitor his condition, as sometimes anisocoria can indicate an issue with the eye or nervous system.
Next Steps
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Monitor Changes: Keep an eye on your son's pupils, looking for any changes in size, color, or responsiveness over the next few weeks, especially if it worsens or is accompanied by other symptoms like lethargy, unusual behavior, or difficulty with vision.
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Document Symptoms: Continue taking pictures of his eyes in different lighting conditions as you have. This will help if you need to discuss any concerns with your healthcare provider later.
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Consult Your Pediatrician If Needed: If you notice any changes in his overall health, vision, or if the asymmetry becomes more pronounced, reach out to your pediatrician for further examination. They may refer you to a pediatric ophthalmologist for a thorough assessment to rule out any underlying issues.
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Listen to Your Instincts: Trust your instincts as a parent. If you feel something doesn't seem right or if you have persistent concerns, don't hesitate to seek professional advice.
You're doing a great job keeping an eye on your son's health and development. If you have any more questions or need clarification on anything, feel free to ask!
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.