Ophthalmology- Pupils Flashcards
Inspection of pupils
Size (2-4mm in bright light; 4-8mm in dark)
Shape (round)
Symmetry
To best see pupillary reflexes…
the room should be dimly lit
Direct pupillary reflex
Shine light into the pupil and observe constriction of the pupil
Slow/lack of reaction: optic nerve/brain injury or drugs
Consensual pupillary reflex
Shine light into pupil but watch constriction of the other pupil
Lack of consensual pupillary reflex
injury to one or both optic nerves
injury to Edinger-Westphal nucleus
Swinging light test
Move the pen torch rapidly between the 2 pupils
Aim of the swinging light test
To check for relative afferent pupillary defect (can be caused by optic neuritis e.g. in MS)
Cover test
Cover one eye and observe the reaction/movement of the contralateral eye
What is the cover test used for?
Used to observe any nerve palsy’s supplying the muscles of the eye
Examining eye movements
Draw an ‘H’ with you finger and watch the patients eyes follow your finger. Watch for any failure to look in a certain direction or nystagmus
Esotropia
convergent squint
the uncovered eye moves OUT
Exotropia
Divergent squint
the uncovered eye moves IN
Hypertropia
uncovered eye moves DOWN
thus it was sitting high to begin with
Hypotropia
uncovered eye moves UP
thus it was sitting lower to begin with
Inferior oblique action
UP and IN
