I am looking for a provisional diagnosis for this patient:
A 55 year old male attends for an eye examination complaining of a difference in pupil size in the last few weeks where he was prescribed glasses for reading only. His general health is good although is aware of an itchy rash on his right cheek. He is a heavy smoker and takes medication for high blood pressure which he thinks is controlled.
Ophthalmoscopy is normal
Refraction reveals: RE +0.50/-0.25x85 6/6 Add +1.00 N5
LE:+0.25/-0.25x95 6/5 Add +2.00N5
Pupils: Right pupil smaller than Left, appears to react normally.
IOP: R 10mmHg L 14 mmHg NCT @12pm
I am unsure whether it is the RE or LE that is affected and therefore can not confirm which of the pupil disorders he is suffering from. Since there is normal pupil responses i am currently thinking either Physiological anisocoria or Horners syndrome.
Someone please help!:)