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The time when it was thought possible to foretell the character of insanity by noting which was the larger pupil has long since passed away. It is also my opinion that when the influence of great altitude upon the general economy shall be better understood, the time when we, as physicians, were inclined to regard inequality of the pupils as more than presumptive evidence of serious lesions, will have become ancient history.
My reasons for bringing this subject (anisocoria) to your notice are many, the main one being to impress upon you that there may be unequal dilatation of the pupils which is in no way indicative of the lesions to which we are commonly in the habit of attributing it. So far as I can learn, but little has been written upon the subject, and that little deals with it as a symptomatic manifestation of graver troubles, such as
BOYD ET. INEQUALITY OF THE PUPILS OBSERVED AT AN ALTITUDE OF TEN THOUSAND TWO HUNDRED AND FIFTY FEET.. JAMA. 1898;XXX(17):970–971. doi:10.1001/jama.1898.72440690030002h