pupillary defects

Question 1

Argyll-Robertson pupil

• causes (2)
• Features

Answer 1

“prostitutes pupil””

a specific finding in neurosyphilis.

• Accommodation Reflex Present (ARP)
• Pupillary Reflex Absent (PRA) no response to light

Features

• small, irregular pupils
• no response to light but there is a response to accommodate

Causes

• diabetes mellitus
• syphilis

Question 2

Third Nerve Palsy

Answer 2

Question 3

constrict vs dilate

Answer 3

Constrict: parasympathetic nerves–>reach eyes via 3rd cranial nerve (oculomotor) inferior division

Dilate: sympathetic nerves

Question 4

what is Anisocoria ?

Answer 4

A descriptive term of unequal pupils.

Question 5

Horner Syndrome

Question 6

name 2 topical mydriatics

Answer 6

tropicamide, atropine

Question 7

Causes of Miosis (Constricted Pupil)

Answer 7

Horny robertson smoked whilemtaking drugs

Question 8

Function of pupils?

Answer 8

The pupil is formed by a hole in the centre of the iris.

1. regulates amount of light entering eye
2. allows passage of aqeous humor from ant to posterior chamber

Question 9

what is this?

describe pathophysiology behind it

symptoms

diagnostic test?

Answer 9

Holmes-Adie syndrome

“Light–near dissociation “

The key feature is an impaired reaction of the pupils to light, while the near response to accommodation is retained.

• common cause of (anisocoria) in young adults
• has NO serious consequences.
• Onset is subacute, affects FEMALES more

ciliary ganglionitis –> denervates parasympathetic supply to iris & ciliary body.

On recovery from the ganglionitis, reinnervation of sphinctor is incomplete –> making the muscarinic receptors supersensitive to cholinergic agonists.

The consequence is that the pupil:

is enlarged – bc the sphincter is relatively denervated

is poorly reactive to light – same above.

slow, sustained constriction on accommodation –> muscarinic supersensitivity of the sphincter

accommodation reflex is impaired –> bc ciliary body is also partially denervated

• constricts to a single drop of dilute pilocarpine (0.1%), unlike the normal pupil. This is a diagnostic test.

Question 10

list some conditions that causes an Abnormal Pupil Shape

Answer 10

• Trauma to the sphincter muscles in the iris can cause an irregular pupil. This could be caused by cataract surgery and other eye operations.
• Anterior uveitis can cause adhesions (scar tissue) in the iris that make the pupils misshapen.
• AACG can cause ischaemic damage to the muscles of the iris causing an abnormal pupil shape, usually a vertical oval.
• Rubeosis iridis (neovascularisation in the iris) can distort the shape of the iris and pupil. This is usually associated with poorly controlled diabetes and diabetic retinopathy.
• Coloboma is a congenital malformation in the eye. This can cause a hole in the iris causing an irregular pupil shape.
• Tadpole pupil is where there is spasm in a segment of the iris causing a misshapen pupil. This is usually temporary and associated with migraines.

Question 11

Causes of Mydriasis (Dilated Pupil)

Answer 11

sherlock HOLMES hat COCAINE at 3AM

• 3rd nerve palsy
• Anti-muscarinic eye drops (ex to facilitate fundoscopy)
• Myotonic pupil (Holmes Adie pupil): most commonly in young women, with absent/delayed reaction to light and convergence, and of no pathological significance.
• COCAINE
• congenital
• Trauma