![]() If only one pupil changes size, there is usually a problem with the brain, or with the optic nerve (the nerve that runs from the brain to the eye). If both pupils change size at the same time, but the change happens slowly, the pupils are called "sluggish." This can be a sign of illegal drug use, hypoxia (not getting enough oxygen to the brain), or injury. This is called being "light-reactive" (the pupils are reacting to changes in light). When the light is taken away, both pupils should get bigger at the same time. When a light is shined in one pupil, both pupils should get smaller at the same time. When one pupil is a different shape, usually the person has had an injury to the eye. ![]() Usually, there is only a small difference in size. In these people, this is normal and does not signal a problem. However, up to 20% of healthy people have pupils that are different sizes. For example, their brain may be injured, or they may have had a stroke. Pupils that are "unequal" (one is bigger than the other) are usually a sign that something is wrong with the brain. In most healthy people, the pupils should be the same size ("equal").
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