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Warning-sign checks

Anisocoria: when to get help

Go through these in order and stop at the first one that applies. If you are reading this for someone else, answer for them.

  1. 1

    Is any of this happening now?

    Call 911

    Seek emergency medical help if unequal pupils appear suddenly with:

    • A severe or unusual headache or neck pain
    • Weakness, numbness, confusion, fainting, or trouble speaking
    • A newly drooping eyelid, double vision, or abnormal eye movement
    • Severe eye pain, redness, blurred vision, or rainbow-like halos
    • A recent head or eye injury

    These combinations may indicate a problem affecting the brain, nerves, blood vessels, or pressure inside the eye.

    Do not drive yourself if your vision or alertness is affected.

    Other emergency signs, for anyone
    • Someone who is struggling to breathe, gasping, choking, or cannot get words out
    • Someone who has chest pain, tightness or pressure lasting more than a few minutes
    • Someone who has sudden weakness or drooping on one side of the face or body, slurred speech, or sudden confusion
    • Someone who is unconscious, or cannot be woken
    • Someone who is bleeding heavily and it will not stop with firm pressure
    • Someone who has had a seizure that will not stop, or does not wake up afterwards
    • Someone who has lips or skin that look pale, blue, grey or blotchy
    • Someone who you believe has taken an overdose or swallowed something poisonous
  2. 2

    Is any of this happening?

    Be seen today

    Arrange a same-day medical or eye assessment for new, unexplained anisocoria, even if you otherwise feel well.

    This is especially important if the size difference is changing.

    Children with new anisocoria should be examined promptly, particularly if there is eyelid drooping or a change in eye movement.

  3. 3

    Does any of this apply?

    Book an appointment

    A routine appointment is reasonable when the difference appears stable and long-standing but has never been assessed.

    Bring older photographs if possible.

Every sign above is quoted from the sofidex article on Anisocoria. If you are not sure, err upward — it is always reasonable to be checked.