Unequal pupils where the smaller one is abnormal;
Sympathetics cause dilation of pupil. Processes interfering w/sympathetics lead to constriction. Sympathetics also innervate small muscle in lid, w/lesions causing element of ptosis too
Physiologic anisocoria: Normal pupils can differ in size by <.4mm. Eye function and response to light will be normal.
Prior eye surgery, trauma, injury to pupilary dilators/constrictors; history should be revealing; license/other pix to assess stability/newness is helpful; shouldn't have acute sx