Different Sized Pupils

[gingergingerginger]

My DS has different sized pupils come of the time. I noticed it a few days ago and got him to the GP, who sent him to an optician, who said there was something wrong with the reactions of his right eye. He noticed a sign called relative afferent pupil defect (RAPD).

We think this started a couple of months ago. He is 7. He has no sight loss, but he does have headaches.

We went back to the GP, who called the paeds, who agreed he needed an urgent referral to ophthalmology, so we're waiting for that appointment now.

My question is: has anyone else had similar with their child? Has anyone heard of uneven pupils AND rapd together (my research says they are different things)? What will they do at the hospital?

They might do a CT scan. It sounds as though they are on the ball so if it’s something nasty they’ll catch it early.

Thank you. I am trying to convince myself it's not something bad because he is well in himself. But then you hear stories about sinister things staying well-hidden for long periods of time.

I've (now) read that having uneven pupils is extremely common. It's the RAPD that's concerning me. I'm wondering if the optician got that wrong. It's what they are looking for when they shine a light from one eye to the other backwards and forwards. It means that one eye isn't responding to that light properly, but it doesn't present with uneven pupils. It usually means something wrong with the optic nerve.

I know I just need to sit back and wait for the appointment, but I am anxious. No idea how long it will take.

I have that. In the morning my pupils are often noticably different sizes. There is no reason as far as the doctor can see.

Thanks @witchend

What tests did they do on you? Did it start suddenly?

I don't know if it started suddenly. I was at university, and one morning I looked in the mirror and saw that my pupils were very different sizes. I don't ever remember seeing it before.
Later on in the day I checked and they were same size.

I went to the doctor and he really wasn't too worried. he did ask if the smaller pupil was towards the light, and it wasn't. He did check for MS I think, and he checked pupil reactions and other reflex reactions (like the knee one)and told me not to worry.
That was over 20 years ago, and I still have it sometimes. Most common in the morning, but not extensively. I haven't had anything else.

I do know that my pupils don't change as much, or as quickly as they should, but still within normal limits. As far as I know the only issue I have with it (and I've had eyes checked many times) is that I do tend to get migraines with bright light shining at me, because they don't close enough, and my night vision isn't brilliant. I can see, but I know when I'm playing tennis I need the floodlights on sooner than most people.

Thanks @witchend . That's really interesting.

It seems to me that when they did the checking pupil reaction part on my DS that's shown up a concern. Nobody will really tell me anymore, though.

I'm just wondering how likely it is that the optician got it wrong.

I think they're more likely nowadays to give it fuller checks than back in my day. Much more covering of backs etc.

For me, most of the time my pupils act together, and just sometimes they're different. I've never noticed them acting different, although obviously they sometimes must do. You can probably check that yourself on him. If they standardly act together then I'd suspect it's one of those things.

Check on yourself too. My ds also occasionally I've noticed it on him (not first thing in the morning) so I assume it may be genetic.

The most likely scenario is that the paed has a quick look and says "yes, one of those things, lots of people have this." But it's worth checking.