7 - Opth - Pupillary reflexes - Constricted pupil

Question 1

2 causes of constricted pupil

Answer 1

Horners syndrome

Argyll roberston pupils

Question 2

What causes Horners (generally)

Answer 2

damage to sympathetic trunk

Question 3

Causes of horners in 1st order neurones

Answer 3

brainstem disease, SC lesions, diabetic autonomic neuropathy

Question 4

Causes of horners in 2nd order neurones

Answer 4

pancoast tumour, carotid/aortic aneurysm/dissection, neck lesions/trauma

Question 5

Causes of horners in 3rd order neurones

Answer 5

cluster headaches, internal artery dissection, otitis media, cavernous sinus mass

Question 6

Mechanism of constriction in Horners

Answer 6

impaired dilatation

so - unopposed constriction

Question 7

Signs of horners

Answer 7

pupil constriction
slight ptosis (weakened mullers muscle)
anhydrosis on affected side (IF lesion below superior cervical ganglion)

Question 8

When do argyll robertson pupils occur

Answer 8

tertiary syphilis -> brainstem lesion - usually bilateral

Question 9

Features of argyll robertson pupils

Answer 9

pupils small and irregular
sluggishly reactive
light near dissociation (accomodate but minimally reactive)