Treatment depends on the cause of the unequal pupil size. You should see a doctor if you have sudden changes in pupil size.

You should see a doctor if you have persistent, unexplained, or sudden changes in pupil size. The new development of different sized pupils may be a sign of a very serious condition.

If you have differing pupil size after an eye or head injury, get medical help immediately.

Always seek immediate medical attention if differing pupil size occurs along with:

• Blurred vision
• Double vision
• Eye sensitivity to light
• Fever
• Headache
• Loss of vision
• Nausea or vomiting
• Severe eye pain
• Stiff neck

The medical history will be obtained and a physical examination performed.

Medical history questions documenting differing pupil size in detail may include:

• Is this new for you or have your pupils ever been different sizes before?
• When did it start?
• What other symptoms are also present?
  • Is there a headache?
  • Is there nausea?
  • Is there vomiting?
  • Is there blurred vision?
  • Is there double vision?
  • Is there a fever?
  • Is there a stiff neck?
  • Are the eyes light-sensitive (photophobia)?
  • Is there eye pain?
  • Is there loss of vision?

The physical examination will include a neurological examination.

Diagnostic tests that may be performed include:

• Blood studies such as CBC and blood differential
• Cerebrospinal fluid studies (lumbar puncture)
• CT scan of the head
• EEG
• Head MRI scan
• Tonometry (if glaucoma is suspected)
• X-rays of the skull
• X-rays of the neck

Depending on the diagnosis, medication may include drugs to control migraine, corticosteroids (to diminish swelling of the brain tissue), anticonvulsant drugs (to control seizures), pain relievers, antibiotics (for bacterial meningitis), or anticancer drugs.