Pupil response 2

Question 1

When do pupils dilate?

Answer 1

In the darkness, low illumination

Question 2

How is dilation innervated?

Answer 2

sympathetic nervous system branch of autonomic nervous system

Question 3

Where do all sympathetic fibres originate?

Answer 3

Superior cervical ganglion

Question 4

What does superior cervical ganglion receive?

Answer 4

Input from cells in the brainstem that synapses to T1

Question 5

Explain the sympathetic innervation of the orbit?

Answer 5

SCG recieve input from brainstem cells and synapse onto T1
>fribres run from SCG up the neck as the internal carotid nerves to level of cavernus sinus
>break into bundles (plexus), around carotid arteries
>pass through optic foremen
>fibres run along optic nerve to the ciliary ganglion
…

Question 6

What is marcus gunns test?

Answer 6

Swinging lights test as the eyes are alternatively illuminated

Question 7

What causes afferent pupil defect?

Answer 7

Optic neuritis
amblyopia
macular disease
retinal detachment

Question 8

What do efferent pathway pupillary defect result to?

Answer 8

Anisocornia (unequal pupil size)

Question 9

Where in efferent pathway can the defect be in?

Answer 9

The midbrain EWN
Third nerve
Ciliary ganglion
iris

Question 10

What is adies syndrome?

Answer 10

Unresponsive tonic pupil due to denervation of the pupil

Question 11

Where is lesion for argyll robertson pupil ?

Answer 11

Midbrain near EWN

Question 12

What is argyll robertson pupil ?

Answer 12

pupil unresponsive to light maintains a near response

Question 13

What is horner’s syndrome?

Answer 13

The pupil of the affected eye is not as dilated as the other eye since the parasympathetic innervation of the dilator is compromised

Question 14

What happens in horner’s syndrome?

Answer 14

Pupil takes longer and less to dilate as it gets darker

Question 15

where is the lesion for horners syndrome?

Answer 15

pupil constriction caused by lesion anywhere in the sympathetic pathway leading to the dilator

Question 16

explain pharmacology of the sphincter?

Answer 16

Blocking the sphincter causes dilation while enhancing its activity results in constriction

• –Pilocarpine - Ach antagonist activating Ach receptors and causing constriction
• –Anti muscarinics will block Ach receptors and result in dilation
• -Anticholinestrase will enhance Ach levels and hence result in sphincter activation and pupil constriction

Question 17

Explain Pharmacology of the dilator?

Answer 17

Activation of the dilator causes dilation while blocking its effects causes pupil constriction?
>increase the release of NA and hence also causes dilation
>dilator can be relaxed by applying alpha adrenergic blockers causing constriction
>cocaine prevents the reuptake of NA and hence causes dilation