Pupillary Disorders

Question 1

Hypoplastic iris

Assoc w/ cataracts, glaucoma, macular/ON hypoplasia

Answer 1

Aniridia

Question 2

AR
Bilaterally displaced pupil (inf-temp), lens in oppo direction
Microspherophakia, miosis, poor dilation
Assoc: severe axial myopia, RD, large K, cataract, transillumination

Answer 2

Ectopia lentis et papillae

Question 3

Inherited as isolated finding

Idiopathic tractional = fibrous tethers margin to peripheral K

Answer 3

Ectopic pupil

Question 4

Inf/inf-nasal notch
Assoc: chorioretinal/ON
Cause: isolation/idiopathic, chromosomal, congenital

Answer 4

Coloboma

Question 5

Spoke-like opacities across pupil

From tunica vasculosa lentis

Answer 5

Persistent pupillary membrane

Question 6

AC cleaveage anomalies

-Peters vs Riegers

Answer 6

P = central
R = peripheral
Corneal defects

Question 7

RAPD

• main cause
• appearance
• assoc

Answer 7

Optic tract lesion = contralateral
Amaurotic pupil
Vision loss

Question 8

Upgaze paresis, head tilt
Contralateral APD
Light-near dissociation

Answer 8

Pretectal pupil - Parinaud syndrome/dorsal MB

Question 9

Pretectal pupil

-where damage is that causes light-near dissociation

Answer 9

Efferent/PNS pathway:

EW -> inf CN3 -> ciliary g. -> sphincter (miosis) & ciliary (accomm)

Question 10

Poor direct, normal consensual
Light-near dissociation
Miosis in darkness

Answer 10

Argyll-robertson

Question 11

Argyll-robertson

• location of lesion
• causes

Answer 11

Fibers b/w pretectal and PNS nucleus

DM, alcohol, neurosyphilis

Question 12

CN3 palsy

• CN3 and PNS fibers
• when suspect aneurysm

Answer 12

PNS are superficial to CN3 = susceptible to compression

CN3 + dilated pupil

Question 13

Poor light response
Loss of accommodation
Decr corneal sensitivity

Answer 13

Tonic pupil

Question 14

Tonic pupil

• lesion location
• gtt

Answer 14

Ciliary g. or short ciliary n.

1% pilo = constriction

Question 15

Idiopathic, women 20-40

Significant miosis with 0.125% pilo

Answer 15

Adie’s

Question 16

Tonic pupil

-tests to run (2)

Answer 16

FTA-ABS/MHA-TP for neurosyphilis

ESR/CRP for GCA

Question 17

SNS pathway for dilation

• controlled by
• innervation origin
• preganglionic synapse
• postganglionic travels

Answer 17

Hypothalamus

T1-T3

Superior cervical ganglion

Carotid plexus around Int carotid, leaves in cavernous sinus -> nasociliary -> long ciliary -> dilator & ciliary (inhib)

Question 18

Dilation lag in dim light

Normal reaction to light and near stimuli

Answer 18

Horner’s

Question 19

Central Horners

• neuron
• common cause
• uncommon cause

Answer 19

1st

Wallenberg (lateral medulla) = ipsi H + poor smooth pursuit + nystagmus

Mesenceph/pontine lesion = H + contralateral CN4 palsy

Question 20

Preganglionic Horners

• neuron
• common cause

Answer 20

2nd

Pancoast - ipsil H

Question 21

Postganglionic Horners

• neuron
• common causes (2)

Answer 21

3rd

Carotid dissection = H + ipsil HA/pain + ocular ischemia

Cavernous sinus lesion = H + any ispil CN3/4/6/V1/V2

Question 22

Horner’s

-cocaine

Answer 22

5-10%

Constriction = good
No response = non-specific location lesion

Question 23

Horner’s

-hydroxyamphetamine

Answer 23

1%

No response = 3rd order/postganglionic
Dilation = 1st/2nd order/preganglionic

Question 24

Horners

-congenital causes, findings

Answer 24

Neuroblatoma, birth trauma

Heterochromia

Question 25

Constriction in darkness (normal in sleep)

Answer 25

Westphal-Piltz

Question 26

May suggest retinal dystrophy

Answer 26

Paradoxic constriction in dark

Question 27

Induced by lateral gaze, pupil of abducting eye > adducting

Answer 27

Tournays