pupil disorders

Question 1

control of pupil restriction

Answer 1

circular muscles in iris stimulated by parasympathetic NS

oculomotor nerve

Question 2

control pupil dilation

Answer 2

dilator muscles stimulated by sympathetic NS

Question 3

causes of abnormal pupil shape

Answer 3

trauma to sphincter muscles
anterior uveitis 
closed angle glaucoma
rubeosis iridis
coloboma
tadpole pupil

Question 4

Coloboma

Answer 4

congenital malformation

can cause a hole in iris causing irreg shape

Question 5

tadpole pupil

Answer 5

spasm in segment of iris causing misshapen pupil

usually temporary + assoc with migraines

Question 6

mydriasis

Answer 6

dilated pupil

Question 7

miosis

Answer 7

constricted pupil

Question 8

causes of mydriasis

Answer 8

3rd nerve palsy 
homes-adie syndrome
raised ICP 
congenital 
trauma 
stimulants e.g. cocaine
anticholinergics

Question 9

causes of miosis

Answer 9

Horner's syndrome
cluster headaches
argyll-robertson pupil 
opiates
nicotine
pilocarpine

Question 10

Third Nerve Palsy - what does it cause

Answer 10

ptosis (drooping upper eyelid)
dilated, non-reactive pupil
divergent strabismus - down and out appearance

Question 11

oculomotor nerve - travel route

Answer 11

travels through cavernous sinus close to posterior communicating artery

therefore, cavernous sinus thrombosis + posterior communicating artery aneurysm can compress and palsy 3rd nerve

Question 12

Third Nerve Palsy - with sparing of pupil

Answer 12

microvascular cause - parasympathetic fibres spared

diabetes
hypertension
ischaemia

Question 13

Third Nerve Palsy - causes of full palsy (i.e full nerve compression)

Answer 13

idiopathic 
tumour 
trauma 
cavernous sinus thrombosis
posterior communicating artery aneurysm 
raised ICP

Question 14

Horner’s syndrome: triad

Answer 14

ptosis
miosis
anhidrosis

Question 15

Horner’s syndrome: caused by

Answer 15

damage to sympathetic NS supplying face

Question 16

journey of sympathetic nerves to face

Answer 16

arise from spinal cord in chest - pre-ganglionic nerves

they enter sympathetic ganglion at base of neck and exit as post ganglionic nerves

post ganglionic nerves travel to head alongside internal carotid artery

Question 17

Horner’s syndrome: central lesions cause

Answer 17

anhidrosis of arm and trunk as well as face

Question 18

Horner’s syndrome: pre-ganglionic lesions cause

Answer 18

anhidrosis face

Question 19

Horner’s syndrome: post-ganglionic lesins

Answer 19

do not cause anhidrosis

Question 20

Horner’s syndrome: causes of central lesions

Answer 20

stroke
MS
swelling - tumour
syringomyelia

Question 21

Horner’s syndrome: causes of pre-ganglionic lesions

Answer 21

pancoast tumour
trauma
thyroidectomy
cervical rib

Question 22

Horner’s syndrome: causes of post-ganglionic lesions

Answer 22

carotid artery aneurysm
carotid artery dissection
cavernous sinus thrombosis
cluster headache

Question 23

Horner’s syndrome: congenital is assoc with

Answer 23

heterochromia - difference in iris colour on affected side

Question 24

testing for Horner’s syndrome

Answer 24

cocaine eyedrops - normal eye will dilate but with Horner’s no pupil reaction

adrenalin eye drop - will dilate Horner’s pupil but not a normal one

Question 25

Holmes Adie Pupil

Answer 25

unilateral dilated pupil , that is sluggish to react to light
with slow dilation of pupil followed by constriction

Question 26

Holmes Adie Pupil - caused by

Answer 26

damage to post-ganglionic parasympathetic fibres

Question 27

Holmes Adie Syndrome

Answer 27

holmes adie pupil

absent knee and ankle reflexes

Question 28

Argyll-Robertson Pupil

Answer 28

neurosyphilis

constricted pupil that accommodates but does not react