Neurophthalmology Flashcards
anisocoria
a difference in size between pupils
Neurophthalmology exam
- look for anisocoria
- check normal reaction to light and dark
- observe pupils in light and dark
- observe papillary response to light
- observe for segmental palsy
- observe for light-near dissociation
- observe for tonic dilation
light-near dissociation
better constriction when viewing a near object than to light stimulation
segmental palsy
unequal constriction of the pupil
Sympathetic pupillary disturbances:
- Sympathetic innervation normally results in papillary dilation.
- If sympathetic pathways are damaged the abnormal pupil will be miotic and will have an abnormal dark reaction, meaning it will not fully dilate.
- This makes the anisocoria worse in the dark.
ParaSympathetic pupillary disturbances:
- Parasympathetic innervation causes papillary constriction, so damage will result in a pupil that is mydriatic and poorly responsive to light.
- The anisocoria thus appears worse in the light.
Horner’s Syndrome: symp or para
sympathetic problem
Horner’s Syndrome: anisocoria
miosis
Horner’s Syndrome: light reaction
abnormal dark reaction
Horner’s Syndrome: other signs
Also accompanied by Ptosis and anhidrosis (usually unilaterally)
Iris Damage: symp or para
Parasympathetic Problem
iris damage: anisocoria
myadriasis
iris damage: light reaction
abnormal light reaction
iris damage: other signs
non-neurologic cause
3rd Nerve Palsy: symp or para
parasympathetic problems
3rd Nerve Palsy: anisocoria
mydriasis
3rd Nerve Palsy: light reaction
abnormal light reaction
3rd Nerve Palsy: other signs
Accompanied by other signs of 3rd nerve damage including ptosis and EOM paresis
Tonic Pupil: symp or para
parasympathetic problem
Tonic Pupil: anisocoria
myadriasis
Tonic Pupil: light reaction
abnormal light reaction
Tonic Pupil: other signs
- Light-near dissociation
(due to regrowth of nerve fibers, more of which are dedicated to accommodation) and - segmental constriction
