Clinical workflow
A patient notices one pupil looks bigger.
OptoGuide™ gives pupil problems a structured neuro-ophthalmic front door — use lighting pattern and red flags to separate benign anisocoria from the dangerous pupils that need urgent assessment.
Structured for Australian optometry practice. Clinically reviewed by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom.
Clinical decision support only
Red flags — assess urgently before anything else
Pupil-involving third nerve features and acute onset raise concern for a compressive or vascular cause and support urgent neuro-ophthalmic assessment.
- Acute or recent onset, especially with headache or neck pain.
- A pupil-involving picture: ptosis, a limited or “down-and-out” eye, or diplopia.
- Anisocoria greater in bright light with a poorly reacting larger pupil.
- Any associated neurological symptoms, or pain around the eye.
One connected workflow, not separate lookups
Recognition, management, prescribing, and referral usually live in different tools. In OptoGuide™ they are one path — each step hands off to the next so the decision keeps moving.
Step 1
Start with the pupil problem
Enter from the presenting complaint. The pathway prompts the observations that actually change urgency — onset, lighting behaviour, and associated lid or motility signs.
- Note whether the difference is greater in bright or dim light.
- Look for ptosis, a motility limitation, or diplopia alongside the pupil.
- Establish onset — sudden change is treated differently from a long-standing difference.
Step 2
Use lighting pattern plus red flags
Capture the lighting-pattern and safety cues together. The screen keeps the dangerous combinations — acute onset, ptosis, motility loss, headache — in view rather than defaulting to a benign explanation.
- Greater in bright light points toward a poorly reacting larger pupil.
- Greater in dim light points toward a smaller pupil that dilates poorly.
- Acute onset with ptosis and a motility deficit is treated as a red-flag combination.
Step 3
Separate benign from dangerous
A rule-based result keeps benign physiologic anisocoria distinguishable while dangerous, pupil-involving patterns are escalated — no probabilistic guessing.
- Pupil-involving third nerve and Horner patterns are held visible for escalation.
- Long-standing, symmetrical-reacting differences are recognised as likely benign.
Step 4
Open the danger workflow
Open the fitting condition for structured recognition and escalation framing. A pupil-involving third nerve palsy is treated as time-critical.
- Recognition and escalation guidance are presented conservatively — no diagnosis is asserted.
- The workflow points to the urgency of assessment, not a specific cause.
Step 5
Escalate with a clear referral
When the picture is neurologically suspicious, draft an urgent referral in the same flow. The letter text is generated for you to review and copy — OptoGuide never sends it.
- Urgency wording is matched to the suspected pattern.
- Copy-first output for your existing referral systems. No patient data is stored.
Clinical basis
This guidance reflects standard optometric clinical reasoning based on:
- Australian optometry clinical practice patterns
- Australian medicines regulation and PBS prescribing context
- Common ophthalmology referral standards
- Evidence-based clinical training and practice
Give the next unequal pupil a structured front door.
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