Pupillary Disorders Flashcards
Hypoplastic iris
Assoc w/ cataracts, glaucoma, macular/ON hypoplasia
Aniridia
AR
Bilaterally displaced pupil (inf-temp), lens in oppo direction
Microspherophakia, miosis, poor dilation
Assoc: severe axial myopia, RD, large K, cataract, transillumination
Ectopia lentis et papillae
Inherited as isolated finding
Idiopathic tractional = fibrous tethers margin to peripheral K
Ectopic pupil
Inf/inf-nasal notch
Assoc: chorioretinal/ON
Cause: isolation/idiopathic, chromosomal, congenital
Coloboma
Spoke-like opacities across pupil
From tunica vasculosa lentis
Persistent pupillary membrane
AC cleaveage anomalies
-Peters vs Riegers
P = central
R = peripheral
Corneal defects
RAPD
- main cause
- appearance
- assoc
Optic tract lesion = contralateral
Amaurotic pupil
Vision loss
Upgaze paresis, head tilt
Contralateral APD
Light-near dissociation
Pretectal pupil - Parinaud syndrome/dorsal MB
Pretectal pupil
-where damage is that causes light-near dissociation
Efferent/PNS pathway:
EW -> inf CN3 -> ciliary g. -> sphincter (miosis) & ciliary (accomm)
Poor direct, normal consensual
Light-near dissociation
Miosis in darkness
Argyll-robertson
Argyll-robertson
- location of lesion
- causes
Fibers b/w pretectal and PNS nucleus
DM, alcohol, neurosyphilis
CN3 palsy
- CN3 and PNS fibers
- when suspect aneurysm
PNS are superficial to CN3 = susceptible to compression
CN3 + dilated pupil
Poor light response
Loss of accommodation
Decr corneal sensitivity
Tonic pupil
Tonic pupil
- lesion location
- gtt
Ciliary g. or short ciliary n.
1% pilo = constriction
Idiopathic, women 20-40
Significant miosis with 0.125% pilo
Adie’s
Tonic pupil
-tests to run (2)
FTA-ABS/MHA-TP for neurosyphilis
ESR/CRP for GCA
SNS pathway for dilation
- controlled by
- innervation origin
- preganglionic synapse
- postganglionic travels
Hypothalamus
T1-T3
Superior cervical ganglion
Carotid plexus around Int carotid, leaves in cavernous sinus -> nasociliary -> long ciliary -> dilator & ciliary (inhib)
Dilation lag in dim light
Normal reaction to light and near stimuli
Horner’s
Central Horners
- neuron
- common cause
- uncommon cause
1st
Wallenberg (lateral medulla) = ipsi H + poor smooth pursuit + nystagmus
Mesenceph/pontine lesion = H + contralateral CN4 palsy
Preganglionic Horners
- neuron
- common cause
2nd
Pancoast - ipsil H
Postganglionic Horners
- neuron
- common causes (2)
3rd
Carotid dissection = H + ipsil HA/pain + ocular ischemia
Cavernous sinus lesion = H + any ispil CN3/4/6/V1/V2
Horner’s
-cocaine
5-10%
Constriction = good
No response = non-specific location lesion
Horner’s
-hydroxyamphetamine
1%
No response = 3rd order/postganglionic
Dilation = 1st/2nd order/preganglionic
Horners
-congenital causes, findings
Neuroblatoma, birth trauma
Heterochromia
Constriction in darkness (normal in sleep)
Westphal-Piltz
May suggest retinal dystrophy
Paradoxic constriction in dark
Induced by lateral gaze, pupil of abducting eye > adducting
Tournays
