ANATOMY - Pupil and Pupillary pathways (reflexes) Flashcards
What is simple anisocoria?
<0.4mm difference in pupil size - present in 25% of the population and may change sides.
What is physiological tremor in pupil known as?
Hippus (pupillary athetosis)
What is physiological anisocoria?
When the difference in size is usually 1mm in diameter or less
1. pupil size disparity is same in the light as in the dark
2. pupils react normally to light.
If anisocoria is greater in the light, which pupil is abnormal?
the larger pupil, the pupil which failed to constrict.
What are the causes of abnormally dilated pupil (ie greater anisocoria in the light?) (4)
- Traumatic iris sphincter muscle - torn pupillary margin or iris transillumination defects.
- Adie Tonic pupil - irregular pupil, reacts minimally to light, and slowly to convergence. Hypersensitivity to pilocarpine 0.125%.
- Third nerve palsy - always associated ptosis or extraocular muscle palsies
- Mydriasis drops
If anisocoria is greater in the dark, which pupil is abnormal
Smaller pupil (pupil fails to dilate).
What are the causes when abnormal pupil is constricted?
- Uveitis
- Horner syndrome - mild ptosis on side of small pupil
- Argyll Robertson pupil - bilateral irregularly round miotic pupils but mild degree of anisocoria
- Pharmacological miosis
What scenarios does mydriasis occur in ?
What scenarios does miosis occur in? (3)
Mydriasis: low light, excitement, fear
Miosis: illumination, convergence, sleep.
What are the effects of pupillary dilation? (5)
- Reduces depth of field
- Reduces depth of focus
- Reduced diffraction of light
- Increased Stiles-Crawford Effect
- Increased chromatic aberration
What is the Stiles-Crawford Effect?
Light entering the edge of the pupil is less effective at stimulating photoreceptors than light entering centrally because it meets the receptors obliquely rather than axially.
What is the difference between Stiles-Crawford effect 1 and Stiles-Crawford effect 2?
effect 1 - greater stimulus effectiveness (brightness) of a ray passing paraxially compared to a ray entering eccentrically.
effect 2: change in hue and saturation of monochromatic light depending on angle of incidence
What is the latency period of the pupil?
Duration from exposure to response - on average 0.2-0.5 seconds
What is the latency period affected by? (2)
- Light intesity - decreases with increasing light intensity
- Accomodation (pupil reacts faster to light than to accomodation)
What is pupil size affected by? (2)
- Iris colour (blue larger than brown)
- Autonomic nervous system (fatigue, exercise, light intensity)
What are the two types of light reflex?
- The direct pupillary reflex
- Consensual pupillary reflex
What is the afferent pathway of the light reflex?
FROM RETINA TO PRETECTAL NUCLEUS
- Fibres leave tract and synapse in pretectal olivary nucleus near superior colliculus
- Each pretectal nucleus only receives ipsilateral input.
What are the 3 pathways of the light reflex?
- Afferent (from retina to pretectal nucleus)
- Internuncial neuron/centre (from pretectal to edinger westphal nucleus)
- Efferent (from edinger westphal, third nerve, ciliary ganglion and short ciliary nerve to sphincter pupillae)