Dr. Pawar Satyajit Jalinder
Medical oncology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am really worried about my 5-month-old daughter. She is crying a lot and vomiting. During crying, giving her breast milk helps for a moment. She is taking Omeprazole and Gaviscon for reflux for three months, but it does not help her. The reflux has been diagnosed after a consultation without any tests. For the last three weeks, my baby started crying more intensively, along with vomit. It looks like she is in pain. For the last two months, her pupil in the right eye is getting bigger than the left one. But sometimes it comes back to the same size as the left one. She had a CT of the head and USG and found nothing. She also had USG of the digestive system and an EEG, and that was fine too. She had a blood test in the hospital, and they came out to be normal. After they discharged us from the hospital, I did a blood test from a private laboratory, showing many abnormalities. I am attaching the blood test report for your reference. Please let me know what kind of problem does it show and what we need to do to find the reason for her bad blood tests. Is there any sign of cancer? Thank you.
Hi,
Welcome to icliniq.com.
I have gone through your query and have looked at the reports provided by you in detail (attachments removed to protect the patient's identity). I can definitely understand your concern.
1. Issue of unequal pupil size- This is called anisocoria in medical terms. In pediatric patients, anisocoria can be physiological (if inequality is 1 mm, it can be due to trauma to the nerves controlling pupil size during childbirth or a tumor of the sympathetic nerves called neuroblastoma leading to Horner's syndrome).
In your daughter's case, I would like to know when the pupil size inequality is the highest. In light or the dark? Also, whether there were any complications during childbirth. As far as I can see from the picture taken in light, both sides have the same color (attachments removed to protect the patient's identity). One important thing is to know which side is abnormal, whether the left pupil is smaller and not changing in size, or the right side is bigger. As CT (computed tomography) of the head and USG (ultrasonography) of the abdomen is normal, I would like to know whether USG of the neck was done. As far as I can see from the investigations, they have tried to look for serious causes like neuroblastoma, retinoblastoma, or brain tumors. If you can provide me with the discharge summary from the hospital, I can look at the investigations done. If everything is normal, then I do not think there is any possibility of cancer.
Thanks.
Patient's Query
Hi doctor,
Thank you for the reply.
Do you think the blood test results are normal, and I do not have to worry about it? Have you checked them thoroughly? I apologize for my question; I am perturbed. Coming to the pupil, the right pupil enlarges much more than the left pupil, and it is an unnatural magnification. Both pupils react to light correctly. They often reduce to the same size, except the left one that often remains slightly larger. In the dark, both get larger. I notice the most significant difference during normal daylight when it is not too bright, but I also have the impression that when playing on the tummy and laughing, the pupil is much larger than the other one.
The pupil started getting big when my baby was about two months old. The color remains the same. She was born in 38 weeks by emergency c-section because of bradycardia of the baby. She also has enlarged lymph nodes on the head and right side of the neck. She has not done USG of the neck. I asked the doctor to do it, but he said it was unnecessary as her lymph nodes are not too big to do that. But I can feel that it is growing, and I feel another one next to it. In the hospital, with the help of an old USG report, they finished the investigation of the eye, but we still do not know the reason. What would you recommend to us to be sure that it is nothing serious? Please reply.
Hi,
Welcome back to icliniq.com.
1. Regarding the issue of abnormal blood tests- I have gone through all three pages of the report (attachments removed to protect the patient's identity). None of the values are too high or out of range. And these values may be deranged in an otherwise asymptomatic baby too. I think there must be some problem in sampling. As these abnormal values cannot be explained by one illness, I would advise you to repeat the blood tests with a proper method to be sure. If she is drinking well, sleeping well, and otherwise active, I would not consider something serious based on the blood reports.
2. Regarding abnormal pupil size- I could think of two possibilities. The enlarging lymph nodes (as felt by you) can compress the nerves in the neck, which regulates pupil size. This can be confirmed with a USG of the neck to see if they are enlarged. But usually, some lymph nodes can be felt in the neck.
I would advise you to do a USG of the neck and get her evaluated by an ophthalmologist to see other pupil reactions. If nothing could be found, it is possible that the difference in size is physiological and will reduce over time.
If you have any more questions, you can revert.
Thank you.
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Medical oncology
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