Pupillary Defects - Holmes Adie, Argyll-Robertson, Marcus-Gunn, Horner's Syndrome

Question 1

Holmes Adie pupil
-what is it
-presentation
-management

Answer 1

Damage to ciliary ganglion and parasympathetic fibres => DILATION

Benign
Young women
Often secondary to viral/bacterial infection affecting ciliary ganglion

No light reflex in affected eye - no PNS activity
Accommodation reflex present but SLOW
0.125% pilocarpine - constriction of affectd eye
-normal eye not affected as the concentration is extremely weak

Blurred vision
Difficulty focusing on near objects

Treatment not needed - benign and no progression
Corrective lenses - improve visual acuity

Question 2

Argyll-Robertson pupil
-what is it
-associations
-presentation
-management

Answer 2

Accommodation reflex present
Pupillary reflex absent

Association with DM, neurosyphilis

SMALL IRREGULAR pupils

No treatment but can address underlying cause

Question 3

Marcus-Gunn pupil
-what is it
-associations
-presentation
-management

Answer 3

RAPD
-defect anterior to optic chiasm => dilation when light shone on affected

Retinal detachment
Optic neuritis
Glaucoma

Identify and address underlying cause to prevent further damage and potential vision loss

Question 4

Horner’s Syndrome
-presentation
-causes and pattern of anhydrosis
-management

Answer 4

Miosis
Ptosis
Anhydrosis - depending on location of SNS chain compression

Central lesion - within SC => anhydrosis of face, trunk, arm
-Stroke
-Syringomyelia
-multiple Sclerosis

Preganglionic lesion - within sympathetic chain => anhydrosis of face
-pancoast Tumour
-Thyroidectomy
-Trauma

Post ganglionic - hitchikes along internal carotid artery, no anhydrosis
-Carotid artery dissection
-carotid aneurysm
-cavernous sinus thrombosis
-cluster headache

Management - ADDRESS UNDERYING CAUSE