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Charis & Ellie vs Ophthamology > Pupil Disorders > Flashcards

Pupil Disorders Flashcards

1
Q

What is the cause of pupil constriction?

A

Circular muscles in the iris which cause constriction

These muscles are stimulated by the PS nervous system using acetylcholine as a neurotransmitter

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2
Q

Where do the fibres of the Parasympathetic system which innervate the eye travel along?

A

Oculomotor (CN III) nerve

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3
Q

How are dilator muscles of the pupil arranged?

A

Like spokes on a bicycle wheel

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4
Q

What is pupil dilation stimulated by?

A

Sympathetic nervous system using adrenalin as a neurotransmitter

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5
Q

Possible causes of abnormal pupil shape?

A
  • Trauma to the sphincter muscles in iris
  • Anterior uveitis can cause adhesions in iris
  • AACG
  • Rebeosis Iridis (usually assoc with poorly controlled diabetes)
  • Coloboma
  • Tadpole pupil (assoc with migraine)
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6
Q

Causes of mydriasis?

A
  • 3rd nerve palsy
  • Holmes Adie syndrome
  • Raised ICP
  • Congenital
  • Trauma
  • Stimulants eg cocaine
  • Anticholinergics
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7
Q

Causes of miosis?

A
  • Horner’s syndrome
  • Cluster headaches
  • Argyll-Robertson pupil (Neurosyphilis)
  • Opiates
  • Nicotine
  • Pilocarpine
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8
Q

What is mydraisis?

A

Pupil dilation

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9
Q

What is miosis?

A

Pupil constriction

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10
Q

Presentation of 3rd nerve palsy?

A
  • Ptosis
  • Divergent strabismus
  • Dilated non-reactive pupil
  • ‘Down and out’ eye position of affected eye
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11
Q

What does the oculomotor nerve supply?

A

Supplies all extraocular muscles except lateral rectus and superior oblique

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12
Q

What happens when muscles aren’t getting signals from CN III?

A

They move outward and downward

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13
Q

The oculomotor causes ptosis how?

A

The nerve also supplies the palpebrae superioris, which is responsible for lifting upper eyelid

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14
Q

Which type of fibres does the oculomotor also contain?

A

Parasympathetic which innervate sphincter muscles of iris, resulting in 3rd nerve palsy causing a dilated fixed pupil

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15
Q

The jouney of CN III?

A

Travels directly from the brainstem to the eye in a straight line
Travels through cavernous sinus & close to posterior communicating artery

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16
Q

What 2 things can cause compression on the CN III nerve resulting in 3rds nerve palsy?

A

Cavernous sinus thrombosis

Posterior communicating artery

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17
Q

Causes of 3rd nerve palsy with sparing of pupils ?

A

Diabetes
Hypertension
Ischaemia

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18
Q

What does sparing of pupils in 3rd nerve palsy indicate?

A

Microvascular causes as PS fibres are spared

19
Q

What is full CN III compression caused by?

A

Compression of the nerve, including PS fibres compression

20
Q

What may full CN III palsy be caused by?

A 
Idiopathic 
Tumour 
Trauma 
Cavernous sinus thrombosis 
Raised ICP 
Posterior communicating artery aneurysm
21
Q

What is Horner’s syndrome?

A

Triad of miosis, anhidrosis and ptosis

22
Q

Cause of Horner’s syndrome?

A

Caused by damage to the sympathetic nervous system supplying face

23
Q

How can the location of Horner’s syndrome be determined?

A

The anhidrosis

24
Q

What do central lesions cause in Horner’s syndrome?

A

Central lesions cause anhidrosis of arm and trunk aswell as face

25
Q

What location of Horner’s syndrome causes anhidrosis of just the face?

A

Pre-ganglionic

26
Q

What type of anhidrosis does post ganglionic Horner’s syndrome cause?

A

NO anhidrosis

27
Q

How can Horner’s syndrome be remembered?

A

4 S’s (Sentral), 4 T’s (Torso/Pre-ganglionic), 4 Cs (Cervical/Post ganglionic)

28
Q

What are sympathetic nerves called when they arise from spinal cord in the chest?

A

Pre-ganglionic

29
Q

Where do sympathetic nerve enter the sympathetic ganglion?

A

At the base of the neck and they exit as post-ganglionic nerves

30
Q

What do post-ganglionic nerves travel alongside?

A

Internal carotid artery

31
Q

Causes of central lesions in Horner’s syndrome?

A

4 S’s

  • Stroke
  • Multiple sclerosis
  • Swelling (tumours)
  • Syringomyelia (cyst in spinal cord)
32
Q

Causes of pre-ganglionic lesions?

A

4 T’s

  • Tumour (Pancoast’s)
  • Trauma
  • Thyroidectomy
  • Top rib (cervical rib growing above 1st rib & clavicle)
33
Q

Causes of post-ganglionic lesions?

A

4 C’s

  • Carotid aneurysm
  • Carotid artery dissection
  • Cavernous sinus dissection
  • Cluster headache
34
Q

What type of Horner’s syndrome is associated with heterochromia?

A

Congenital Horner Syndrome

35
Q

Investigation for Horner’s syndrome?

A

Cocaine eye drops

Low concentration adrenalin eye drop (0.1%)

36
Q

What do cocaine eye drops convey in the investigation of Horner’s syndrome?

A

Cocaine acts on the eye to stop noradrenaline re-uptake @ neuromuscular junction

  • Tis causes normal eye to dilate because there is more NA stimulating dilator muscles of iris
  • In Horner’s syndrome, nerves aren’t releasing NA, so blocking reuptake doesn’t make a difference
37
Q

How do adrenalin eye drops work as an investigation?

A

Will dilate a normal pupil BUT won’t dilate a Horner Syndrome pupil

38
Q

What is Holmes Adie Pupil?

A

Unilateral dilated pupil that is sluggish to react

39
Q

Presnetation of Holmes Adie Pupil?

A

Slow dilation of the pupil following constriction

Over time the pupil will get smaller

40
Q

Cause of Holmes Adie pupil?

A

Damage to post-ganglionic PS fibres

Exact cause unknown but most likely viral

41
Q

What is the Argyll Robertson pupil?

A

Constricted pupil that accommodates when focusing on a near object but does not react to light
Often irregularly shaped

42
Q

What disease is Argyll Robertson pupil a common finding in?

A

Neurosyphilis

43
Q

What is another common name for Argyll Robertson pupil?

A

Prostitutes pupil
|
Because of relation to syphilis and because it accommodates but doesn’t react

Charis & Ellie vs Ophthamology (40 decks)

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