7 - Opth - Pupillary reflexes - Dilated pupil

Question 1

two causes of dilated pupils

Answer 1

CN III plasy

Adie’s pupil

Question 2

What defect characterises dilated pupils

Answer 2

efferent pupillary defect EPD

Question 3

3 possible causes of CN III palsy

Answer 3

midbrain infarction/tumour
mononeuropathy (DM/atheroma),
aneurysm of posterior communicating artery

Question 4

What lesions may spare the pupil and why

Answer 4

Medical lesions (diabetic neuropathy) - as fibres travel in part of nerve unsupplied by vasa nervorum

Question 5

3 features of CN III palsy

Answer 5

eye looks down and out
complete ptosis
fixed dilated pupil ( no constriction in affected eye, but direct and consensual reflex present in unaffected eye)

Question 6

Adie’s pupil - more frequent in? due to? usually?

Answer 6

young women
post-viral denervation of ciliary ganglion
usually unilateral

Question 7

2 eye features of Adie’s

1 feature of Holme-Adies syndrome

Answer 7

constriction is sluggish - may be vermiform movements
dilated often irregular pupil

abnormal tendon reflexes

Question 8

How to confirm Adie’s

Answer 8

very dilute pilocarpine

Rapid contrction of effect pupil and minimal constriction in normal pupil