This guideline last updated 06/05/2022 17:40:58

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