Disorder of the Pupil Flashcards
Name, Description of this condition
Name: Adie (tonic) pupil
Description: A type of Anisocoria. Caused by parasympathetic denervation of the iris sphincter muscle. Presents as a large pupil in young women with or without visual symptoms. Causes can be idiopathic, orbital trauma, surgery, varicella zoster infection etc.
Signs and Symptoms of this Condition - Adie (tonic) pupil
Signs and Symptoms: Pupil exhibits light-near dissociation and will slowly dilate following accommodative constriction. Pupil constriction is sectorial or vermiform. Usually unilateral at onset. Involved pupil may become miotic with time
How do you distinguish Adie (tonic) pupil from a normal pupil?
Denervation hypersensitivity to direct-acting cholinergic drugs is useful in distinguishing an Adie pupil from a normal pupil
What is the work up for diagnosing adie (tonic) pupil?
Work up: History taking, Ocular examination – pupil size, pupil reactions
Name, Description and Signs/Symptoms of this conditions
Name: Argyll - Roberston Pupill
Description: Frequently associated with syphilis. Presents as small pupils (almost always bilateral). Prompt, apparently normal pupil constriction to near targets
Signs/Symptoms: Little or no constriction to direct light
Describe RAPD
Relative Afferent Pupillary Defect (RAPD) - Marcus Gunn Pupil
A condition in which the two pupils respond differently to light stimuli shone into each eye due to a unilateral or asymmetrical disorder of the retina or optic nerve. Differences between the two eyes in the afferent pathway
What are the grades for RAPD?
Scale of RAPD
Grade 1+: weak initial pupillary constriction followed by greater redilation
Grade 2+: initial pupillary stall followed by greater redilation
Grade 3+: immediate pupillary dilation
Grade 4+: no reaction to light (amaurotic)
What test is used to diagnose an RAPD - Marcus Gunn Pupil?
The ‘swinging-flashlight test’ is used to detect a RAPD:
If positive RAPD (abnormal result), there is less pupil constriction in the eye with the retinal or optic nerve disease.
Name and Description of this Condition
Horner’s Syndrome
The majority of cases are unilateral. Causes of bilateral involvement include cervical spine injuries and autonomic diabetic neuropathy. Painful Horner syndrome, especially of acute onset, should raise the possibility of carotid dissection
What are the signs for Horner’s syndromes?
How do you diagnose Horner’s Syndrome?
Diagnosis confirmed with reversal of anisocoria with apraclonidine (0.5% or 1%) – miotic pupil will be larger after dilation
A third-order neuron disorder may be distinguished from a firstorder and second-order neuron disorder with hydroxy amphetamine
What is pupillary block glaucoma?
A condition in which there is apposition of the iris to the lens or anterior vitreous, preventing aqueous from flowing from the posterior to the anterior chamber. The pressure in the posterior chamber rises, resulting in anterior bowing of the peripheral iris and obstruction of the trabecular meshwork
What is non pupillary block glaucoma?
Plateau iris has a flat iris with a normal anterior chamber depth, filtration angle is very narrow with iris bent sharply backward over anteriorly positioned ciliary process
Important in Far Eastern patients. Characterised by persistently narrow angle capable of closure, in a patient who already had an iridotomy.
Causative factors include 1) plateau iris and 2) a thicker more anteriorly positioned iris in patients of Far Eastern ethnic origin. Plateau iris has a flat iris with a normal anterior chamber depth. filtration angle is very narrow with iris bent sharply backward over anteriorly positioned ciliary process.
What is lens induced pupillary block glaucoma?
Lens thickens and closes angle. Seen in Morgagnian cataract (phacomorphic glaucoma) or anterior lens subluxation. Treated by lens removal
