Pt with Unequal Pupils

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Tonight was just one of those work nights from hell.

Anyway, to the point:

I work in a gero-psych unit and work 3-11. Pt was stable throughout shift, but at around 2100 when I was passing evening meds, I noticed her pupils...one was larger than the other. Took vitals, A&O, behavior monitored, all WNL. Strength in arm equal and strong, no slurring of speech, face symmetrical. Paged MD. During the wait, notified House Supervisor. HS didn't provide anything, pretty much said just wait until MD calls back. MD called back, no new orders, MD will visit in the morning.

I documented all of this in the chart and endorsed it to the next shift. Did I do the right thing? How could this have happened? I'm just so worried. The pt was asleep when I woke her around 2100 and was a bit difficult to arouse, but she eventually became awake and alert.

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Specializes in ED, CTSurg, IVTeam, Oncology.

Anisocoria, or unequal pupils, as a singular presentation without any other neurological sign or symptom, is generally benign. It is considered a normal physiologic variant in about 20-25% of the population.

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I have unequal pupils and it's barely noticible. The only person who usually catches it is an opthomologist.

You did the right thing though. You observed it and did your assessment and then called the physician. That's about all you can do.

If there is something that is really concerning and the physician doesn't want to come in then you have to follow you chain of command and go from there.

Your patient was stable though.

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Specializes in Psych ICU, addictions.

I was assessing a patient who had unequal pupils--I thought it may have been due to the opiate use (especially since one was really dilated while the other wasn't), but she told me that she had them since childhood. She was perfectly fine otherwise...I still let the MD know just to cover myself.

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I use allergy eye drops on a regular basis (naphazoline hydrochloride) and it dilates my pupils. If only one of my eyes gets itchy, I will just medicate that eye, then a few hours later I look in the mirror and I look really weird!!

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The other possibility is an old injury, had the unequal pupils been documented in the chart before or was it new? I once had a patient with unequal pupils who had a hx of a nail penetrating her eye.

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Specializes in M/S, Tele, Sub (stepdown), Hospice.
Anisocoria, or unequal pupils, as a singular presentation without any other neurological sign or symptom, is generally benign. It is considered a normal physiologic variant in about 20-25% of the population.

I just rounded with a NP who told me the same thing & said it was actually fairly common among the elderly.

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No, it was never documented before and I've been assigned this pt for the past 3 days and her pupils were normal. It was a new occurance, so that's why I was worried about it.

Thanks for the info, I didn't know how common it was.

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Specializes in LTC, Subacute Rehab.

Patients who have had cataract surgery can sometimes have oddly-shaped pupils, in addition to not matching the mate in size!

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Specializes in ER, Trauma.

You did an excellant job. Faced with an unknown change in a patient, you did exactly what you should have. Nice job!

During a lunch break (10 minutes, of course) a co-worker exclaimed about my having unequal pupils, totally new for me. In the mirror my right pupil was huge. I ended up having to take a drug test (negative) saw an opthalmologist who said I must have rubbed some drug in my eye (yeah, right), then another opthalmologist who dx'd anascoria. So the whole ER staff learned about anascoria, and I list it in my medical history and add "no burr holes please."

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Specializes in ED, CTSurg, IVTeam, Oncology.
you did an excellant job. faced with an unknown change in a patient, you did exactly what you should have. nice job!

during a lunch break (10 minutes, of course) a co-worker exclaimed about my having unequal pupils, totally new for me. in the mirror my right pupil was huge. i ended up having to take a drug test (negative) saw an opthalmologist who said i must have rubbed some drug in my eye (yeah, right), then another opthalmologist who dx'd anascoria. so the whole er staff learned about anascoria, and i list it in my medical history and add "no burr holes please."

lol... another "blame the nurse" scenario; they should have given you a head ct instead. maybe they suspected you of using belladonna on your eyes to artificially dilate them and make yourself look beautiful? :down:

for a real good read on anisocoria

support your nursing unions!!! :up:

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