In assessing a 59-year-old with unequal pupils, what is MOST pertinent to ask about his medical history?

• A. has a history of eye surgeries
• B. noticed the change during a meal
• C. regularly sees a family physician
• D. is allergic to any medications

Answer: (A)

Unequal pupils, or anisocoria, can arise from problems in the eye itself, the nerves that control the eye, or medications used around the eye. The most useful question to ask is whether the patient has had eye surgeries, because ocular procedures can directly affect how the iris functions or what eye drops were used after surgery. This history can explain changes in pupil size without immediately pointing to a neurological emergency, and it helps guide the appropriate exam and management.

Other options don’t fit as well. A change noticed during a meal isn’t a typical trigger for pupil size differences, and regular contact with a family physician is too nonspecific to explain anisocoria. An allergy history matters for medication safety but doesn’t directly account for asymmetric pupils.