Abnormal pupil Flashcards

1
Q

Features of Argyll-Robertson pupil?

A

Small, irregular pupils?
No response to light by there is a response to accommodate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Handy mnemonic used for Argyll-Robertson Pupil?

A

Argyll-Robertson Pupil= ARP= Accommodation Reflex Present (ARP)
Pupillary Reflex Absent = PRA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of Argyll Roberston pupil?

A

DM
Syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

An abnormally large pupil has three causes you should know (capsule) …

A

Pharmacological

Third nerve palsy

Acute glaucoma

(only say ‘Holmes Adie’ having named these first three causes).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

An abnormally small pupil has which one essential cause we should know ….(capsule) …..

A

Horners syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Holmes-Adie pupil?

A

Benign condition most commonly seen in women. Ddx for dilated pupil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Features of Holmes-Adie pupil?

A

Unilateral in 80% cases
Dilated pupil
Once the pupil has constricted, remains small for an abnormally long period of time
Slowly reactive to accommodation but very poorly to light

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Association of Holmes-Adie pupil?

A

Usually occurs in young females
Association of absent knee/ ankle tendon reflexes

= “Holme-Adie syndrome”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What’s an RAPD?

A

Relative afferent pupillary defect, found by the swinging light test
Caused by a lesion anterior to the optic chiasm (optic nerve or retina)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you perform the swinging light test?

A

Shine light into eye :
normal eye: both pupils will constrict appropriately to light (direct and consensual response).
Affected eye: pupil constriction is slow and may be incomplete

Swinging light test:
Shine a light into one eye, swing it into the other eye (3-4 secs in each eye), and so on back and forth.

RAPD swinging test finding: when shine light in the affected eye : both eyes will dilate, or constricts briefly followed by dilatation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Causes of RAPD

A

Retinal detachment
Optic nerve- optic neuritis (MS)- most common cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the pathway for the pupillary light reflex?

A

afferent: retina → optic nerve → lateral geniculate body → midbrain

efferent: Edinger-Westphal nucleus (midbrain) → oculomotor nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ddx of abnormal pupils?

A

Miotic ‘small’ pupils
* Drugs e.g. opiods, pilocarpine for acute glaucoma
* Horners syndrome (sympathetic pathway disruption
* Argyll-Robertson pupil

Large ‘mydriatic’ pupil
* Third nerve lesions e.g. PCA anyeurysm
* Holmes-Adie pupul
* lesion in eye e.g. acute glaucoma
* drugs; atropine, adrenaline

Other
* Inflammation - Uveitis (posterior synchiae due to adhesions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of mydriasis? (Large pupil)

A

Third nerve palsy
Homes-adie pupil
Phaeochromocytoma
Congenital
Traumatic iridologist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drug causes of mydriasis (large pupil)?

A

Topical mydriatics - tropicamide, atropine
Sympathomimetic drugs - amphetamines, cocaine
Anticholinergic drugs - tricyclic antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly