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Heterochromia

Also known as heterochromia iridis, two different coloured eyes

Two differently coloured irises — usually something you were born with, occasionally something that developed.

About 1 minute to read

Overview

Iris colour comes from melanin in the front layers of the iris. When the amount differs between the two eyes, you get complete heterochromia; when it differs within one iris — a wedge or a ring of another colour — it is called sectoral or central heterochromia.

Congenital heterochromia is present from infancy, stable for life, and almost always entirely benign. Acquired heterochromia, where an iris changes colour in adulthood, is the version that deserves an exam, because the colour change is a sign of something else happening in the eye.

What are the common symptoms?

  • One iris a different colour from the other
  • A wedge or ring of different colour within one iris
  • No symptoms at all, in the congenital form
  • Colour change with a drooping lid or a small pupil (acquired)
  • Colour change with redness, pain or light sensitivity (acquired)

What causes it, and who is at risk?

Most cases are simply genetic, with no associated condition. A minority of congenital cases are linked to Waardenburg, Horner or Sturge-Weber syndromes, or to congenital glaucoma — which is why a first-time finding in a child gets a full eye exam.

Acquired causes include chronic uveitis (Fuchs heterochromic iridocyclitis), pigment dispersion, previous injury or surgery, iris tumours, and the prostaglandin eye drops used for glaucoma, which permanently darken a lighter iris in the treated eye.

How is it treated?

Congenital heterochromia needs no treatment. It is a cosmetic characteristic, not a defect, and vision through both eyes is normal.

Acquired heterochromia is treated by treating the cause: controlling inflammation in uveitis, monitoring pressure where pigment is being released, or assessing an iris lesion. Coloured contact lenses can even the appearance out for anyone who wants that, and should be fitted properly rather than bought as a costume item.

When to get seen quickly

An iris that changes colour in adulthood, or heterochromia appearing alongside a drooping eyelid, an unequal pupil, pain or light sensitivity, should be examined promptly. New heterochromia in an infant warrants a paediatric eye exam.

This page is general information, not a diagnosis. Only an eye care professional who has examined you can tell you what is actually going on.

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Related conditions

Glaucoma Progressive damage to the optic nerve that steals peripheral vision silently — which is why screening matters more than symptoms. Uveitis Inflammation inside the eye — painful, light-sensitive, and needing prompt treatment to protect vision. Dry Eye Syndrome Burning, gritty, tired eyes — and often watery ones — caused by a tear film that is not doing its job. Conjunctivitis Inflammation of the clear membrane over the white of the eye — viral, bacterial or allergic, and treated quite differently in each case.
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