9 - Ant Seg Pupil, Cornea

Question 1

Anisocoria

Answer 1

> 2mm difference in pupil size

Question 2

Physiological anisocoria

Answer 2

Unequal pupils, =1mm difference in both dim and bright light

Question 3

Adie’s tonic pupil

Answer 3

Abnormal larger pupil

Anisocoria greater in bright
Response at near > response to light

Sluggish pupil, segmental response to light
Greater than normal response to pilocarpine
Slower tonic re-dilation is diagnostic

Question 4

Horner’s

• what/symptoms
• etiology

Answer 4

Abnormal smaller pupil

Anisocoria greater in dim (unaffected eye dilates more)

PAM = ptosis, anhidrosis, miosis
-ptosis secondary to paralysis of muller muscle

Congenital or acquired

• C cases have iris heterochromia (affected is lighter)
• A cases with no trauma/surgery require imaging of brain, neck, chest

Question 5

Horner’s

• diagnosis
• causes

Answer 5

Confirm dx with topical cocaine (2-10%) - H pupil won’t dilate
Apraclonidine (0.5-1%) can be used -H pupil will dilate

Trauma, surgery, neuroblastoma affecting SNS chain in chest

Question 6

Punctate epithelial erosion

Answer 6

Seen in children with:

• lagophthalmos
• dry eye
• CL overwear