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A. M. Hendrick, T. Curtis, A. Drack, R. Braverman; Pediatric Anisocoria: A 3 Year, Single Institution Experience. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5271.
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The purpose of this study was to define the etiologies of anisocoria in the pediatric population.
A retrospective chart review was performed on 55 pediatric patients (<18 years old) with anisocoria at a single institution pediatric ophthalmology service from 2003-2006. IRB approval was obtained.
29 of the 55 (53%) patients with anisocoria were diagnosed with Horner syndrome with 14 of those 29 (48%) having an identifiable etiology. Most common etiologies were heart surgery, birth trauma, cervical lymphadenopathy and other trauma including non-accidental trauma. At an incidence of 72%, ptosis is more commonly identified in our patients with Horner syndrome than iris heterochromia with an incidence of 45%. 1 of the 10 (10%) tested for abnormal serum or urinary markers of neuroblastoma returned as positive. 6 of the 29 (21%) patients with Horner syndrome had abnormal imaging of the brain or neck revealing two teratomas, two cases of craniosynostosis, one with encephalomalacia, and two patients with cervical lymphadenopathy.After Horner syndrome, the next most frequently identified causes of pediatric anisocoria in this analysis were physiologic with 9 patients, followed by undetermined with 5 patients, postoperative (both cataract surgery and ROP laser) with 4 patients, and lastly traumatic (non-Horner anisocoria) and tumor-associated anisocoria each affecting 3 patients. Iritis and adie’s pupil each affected one patient resulting in anisocoria.
Pediatric anisocoria is highly associated with Horner syndrome with a high incidence of identifiable etiologies. A simple thorough medical, surgical and birth history will uncover a likely etiology history in a majority of patients. In addition, routine imaging of the head, neck, chest and abdomen along with testing of urine and serum for catecholamines are useful.
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