Pupillary Assessment 4% Flashcards
Which nerve pathway originates from cortex(sensory)?
Efferent
Which muscles are innervated by fibers that are carried superficially on 3rd CN?
Ciliary and Iris Sphincter
Which nerve pathway originates in the retinal receptor cells and lead to the cortex (motor)?
Afferent
_____________tests integrity of anterior visual system.
Afferent nerve pathway
Where do nasal fiber cross?
At the chiasm
Temporal fibers are on which side of the body?
They remain on the same side of the body.
What is the normal shape of the pupil?
Round
A not normal or irregular pupil can be cause by……..
Surgery, Synechiae, Trauma, Acute Angle Closure GLC
Size of pupil varies with……..
Age, refractive error, or color of Iris.
Do light colored iris, myopes, and children usually have large or small pupils?
Large
There is no clinical condition in which the light reflex is ______ and the near response is _________.
Present
Absent
What does the Near Reflex Triad consist of?
Accommodation
Convergence
Pupillary constriction
With Light-Near Dissociation ___________ is absent or abnormal and ________is intact>
Light Reflex
Near Response
*Condition in which pupil is > 1 mm difference in size
Anisocoria
With anisocoria pupil should be measured and documented in ………
dark and light
also lid position and iris color should be documents
Nasal fibers cross at the chiasm, temporal pupillary fibers remain on the _____side of the body
Same
*What are some causes of anisocoria?
Horner’s syndrome, 3N palsy, Adie’s pupil, siderosis Bulbi, trauma, pharmacologic agents, physiologic anisocoria(heterochromia)
Condition that is acquired/congentital, benign. Causes ptotic lid, anisocoria, and heterochromia(2diff color irises, light color on side with ptotic lid). Can be caused by lung cancer, trauma, corpus artery aneurism. Pt does not have sweating on the side of face with ptotic lid.
*Horner’s Syndrome
Condition in which pt has anisocoria, larger pupil will not have ptotic lid. Tested with 2.5 methacholine.
Adie’s pupil
*With this condition anisocoria is greater with bright lights on, less with dim lights. Ptotic lid on the side with larger pupil
Third nerve palsy
Diabetic 3rd Nerve Palsy will_____ have pupil involvement
Not
Rust in eye, can cause anisocoria and heterochromia, can darken the iris with FB.
Siderosis Bulbi
When check pupils have or fixate in a ____target, Have a _____lit room, have a ____light in hand. Measure pupils in ______light and _____illumination.
Distant
Dim
Bright
Ambient
Indirect
What can you use to measure pupils?
Pupil gauge
What does PERRLA stand for?
Pupils equal, round, reactive to light , and Accommodative
What are the steps to evaluating pupils?
- Size and shape (indirect light)
- If anisocoria, check size in light and dark
- Reaction to direct light testing
- Reaction to consensual light testing
- SWIFT
Pupils should constrict ____ and have a ____dilation to normal size folllowed by a state of unrest known as____
Briskly
Slow
Hippus
What does the amount of constriction and redilation depend upon?
The ambient illumination and brightness of the test light.
In the normal eye characteristics of the pupil reaction will be the ___ in ____ eyes
Same
Both
RAPD is also known as…
Marcus Gunn pupil
*An afferent defect, nerve pathways fail to properly transmit messages, can be mild to severe (trace to 4+), always is a sign of an underlying disorder. Usually caused by ON disorder
RAPD(Marcus Gunn pupil)
*Marcus Gunn Pupil (RAPD) is usually caused by….
Optic Nerve Disorder
An APD with only 1 reactive pupil.
Revers Marcus Gunn Pupil
In Reverse Marcus Gunn Pupil, if the abnormal eye is the eye with the fixed pupil of the normal eye will ________ when the light is shined directly in it and will ______ when the light is shinned in the opposite eye. If the abnormal eye is the eye with the reactive pupil, then the pupil will______when the light is shined in the opposite eye and will_____when the light is shined directly into it.
Constrict briskly
Dilate
Constrict
Dilate
