Table 6

Diagnostic features of the common pupillary abnormalities

Physiological anisocoriaThird nerve palsyAdie's pupilHorner's syndromeAtropinised pupil
Clinical featuresAnisocoria. Pupils react to light and accommodation. Difference in pupil size is the same in all light levelsFixed dilated pupil. Other features of a third nerve palsyAnisocoria. Irregular pupils. No or poor response to light. Tonic response to accommodation. Vermiform movements on slit lampPartial ptosis. Miosis Anhydrosis. Enophthalmos. Difference in pupil size increases in dim lightFixed dilated pupil
Pharmacological testing of affected pupilSmaller pupil: Cocaine: dilatation. Apraclonidine: no dilatation Larger pupil: 0.1% Pilocarpine: no constriction0.1% Pilocarpine: constriction may occur0.1% Pilocarpine: constrictionCocaine: no dilatation. Apraclonidine: dilatation. Hydroxyamphetamine: dilatation with a preganglionic lesion0.1% Pilocarpine: no constriction