Pupil Evaluations Flashcards
Pupils can be evaluated on a scale of __ to __
0 to 4 (2 and 3 are gradients in between. 0 means there was no reaction, NLP. 4 is a fast and crisp reaction)
A fast, crisp construction of the pupil can be recorded as
4+ or 4
Corectopia
A misplaced pupil. Not centered. Either developmental or trauma (trauma is more likely).
Anisocoria
Unequal pupil size
Miotic
Small, constructed pupil. This can also be a drug classification that constructs the pupil. Not very common.
Mydriatic
A drug classification that dilates the pupil. Paralyzation of spinster activation of dilator. Paralyzation of spinster activation of dilator.
Direct light reflex
The constriction of the pupil to light, as observed in the illuminated eye.
Consensual light reflex
The constriction of the pupil to light, as observed in the fellow eye.
Sphinctor muscle
One of the iris muscles, responsible for constriction (parasympathetic innervation)
Dilator muscle
One of the iris muscles, responsible for dilation (sympathetic innervation) Fight or flight- take in lots of light.
Accommodative/near reflex
The constriction of the pupil in response to accommodation or a near stimulus. Not normally done, Add on if something abnormal is found.
Marcus gunn reflex
Paradoxical (seemingly absurd) dilation to a bright light, a sign of optic nerve disease. Relative. Afferent pupillary defect. (Relative)APT.
Pupillary pathway
Optic nerve to the optic tract.
Optic tract to the pretectal nucleus (mid brain) where they synapse. Here, they send epsilateral and contralateral fibers.
The fibers then cross and go to the edinger westphal nuclei.
From Edinger westphal nuclei to cranial nerve III.
The fibers then go to the ciliary ganglion where they synapse.
After the synapse, they go to the inferior branch of CN III, then onto the sphincter.
Criteria when setting up for an anisocoria check
Dim lighting
Patient fixation at distant target- large E or muscle light.
Amaurotic pupil
Manifested in an eye with no light perception
NLP
Eyeball= off
connection= eye
What happens when you do direct and consensual responses on a patient with an amaurotic pupil
No direct response in the blind eye (NLP)
No consensual response in the good eye
Direct response in the good eye
Consensual response in the blind eye
Positive APD in the blind eye. 0
Argyll-Robertson Pupil
Prostitute pupils
Small, irregular pupils, which do not react to light, but do have a positive accommodation response.
Main cause is CNS syphilis, but can also be caused by diabetes, alcoholism, and mid-brain tumors.
Aide’s tonic pupil
Aide’s for the ladies. Tonic- pupils do not like to move. A benign condition, where the affected pupil is dilated in bright illumination. The pupil shows no immediate response to bright light, but may eventually show some construction with sustained exposure. Slow. Stuck.
This condition is usually unilateral and begins during the 3rd to 5th decade of life.
What happens when you do direct and consensual response on aide’s tonic pupil?
Shine light in the bad eye and it will take some time for that pupil to constrict, but eventually, it will. Good eye will have a quick consensual response.
Horners triad
Ptosis (droopy lid)
Miosis (small pupil)
and anhydrosis (no sweating)
All of these only occur on the affected side.
A variety of vascular, traumatic, or neoplastic lesions interruprt the oculosympathetic pathway to CN III.
A horners pupil will not dilate quickly after bright light exposure.. will take longer for it to re-dilate after light is shined into the eye and then removed.
MUST REFER. Possible lung tumor
Marcus-Gunn pupil
Poorer direct response than consensual response in the affected eye. The afferent pupil defect is a sign of optic nerve/neural disfunction.
If light is directed into the diseased eye, it is like the patient going into a dark room= pupils dilates.
