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Visual System Anatomy > Pupillary Pathway > Flashcards

Pupillary Pathway Flashcards

1
Q

near pupil response pathway efferent

A 
cn3 sphincter (miosis) + cb (acc) 
-Mr convergence
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2
Q

consensual pupillary light response

A

constriction of contralateral eye

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3
Q

dorsal midbrain- pineal gland

A
  • paralysis of upgaze bilateral
  • convergent refraction syndrome- eyes converge with trying to look up
  • eyelid retraction
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4
Q

Disruption of the efferent sympathetic pathway: Horner syndrome
pathway - preganglionic

A

spinal cord –> apex of lungs –> superior cervical ganglion

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5
Q

disruption in the central nervous system pathway causes

A

lesion of the midbrain can affect the tract between the pretectal and EW nucleus

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6
Q

dorsal midbrain syndrome

A
  • bilateral light - near dissociation
  • pupils are normal to mid-dilated
  • most commonly due to pineal gland abnormality
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7
Q

in efferent sympathetic pathway is anisocoria better or worse in dim illumination

A

worse

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8
Q

efferent parasympathetic pathway causes- cn3 palsy

A
  • also innervates sr, mr, io, ir, levator sphincter, cb
  • ischemic lesion –> pupils spared
  • aneurysm –> pupils involved
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9
Q

causes of RAPD retina

A

large lesion needed bc fibers are spread out

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10
Q

physiological anisocoria

A
  • 20% of pop, can switch eyes
  • more apparent in dim illumination - sympathetic, but no other problem
  • <1 mm difference
  • reactive to light + acc
  • no dilation lag (usually seen w/ horner’s)
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11
Q

RAPD brachium

A

RAPD with normal vision (only place this happens)

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12
Q

efferent parasympathetic pathway cause- pharmacologically dilated pupil

A
  • fixed dilation, worse in bright
  • pharm testing 1% pilocarpine
  • 0.13% pilo –> constriction = tonic
  • 1% pilo –> remains dilated –> pharm dilated pupil
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13
Q

what is light-near dissociation

A

near pupil response bypasses the central portion of the pupillary light response
-acc, convergence, miosis

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14
Q

argyll roberston pupil

A 
-bilateral light near dissociation
(-) light (+) acc
-without light stimulus the pupils will be very small <1mm
-most commonly due to neurosyphilis 
also due to Dm, chronic alcoholism , ms
-lesion likely in central light pathway
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15
Q

Pharmacologic testing

  1. Diagnostic: 5-10% ophthalmic cocaine
    a. Indirect acting adrenergic agonist
A 
normal = dilation 
horner's= no dilation
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16
Q

efferent lesion light near

A

affects near + light response due to overlap of pathway

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17
Q

cataracts and RAPD

A

cataracts do not cause an ipsilateral RAPD

  • cataract –> spreading light –> more fibers simulated –> other eye may look like it has APD
  • if cataract and APD then its not cause- look for something else
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18
Q

efferent parasympathetic pathway cause- tonic pupil

A

-caused by damage to the ciliary ganglion or short ciliary nerves
-segmental constriction- only segment of iris constriction (purse-string effect- not uniform constrction -slow)
-decreased corneal sensitivity
-slow and prolonged near pupillary response (light near dissociation)
-cholinergic denervation supersensitivity
(when some nerves are damaged the remaining nerves are supersensitive; dilted 0.13% pilocarpine will constrict these nerves)

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19
Q

pancoast tumor

A

tumor at apex of lungs

- injury to thoracic area (heart surgery)

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20
Q

efferent parasympathetic pathway cause- damage to iris

A

trauma- post surgery
inflammation- syneichiae
ischemia- due to angle closure, will have high pressure

21
Q

RAPD grading

grade 3

A

immediate dilation

22
Q

horner’s + cn6 palsy

A

look @ cav sin likely aneurysm of ICA within sinus, cannot abduct, ptosis, miosis

23
Q

causes of RAPD optic nerve

A

very small lesion –> very large APD b/c fibers are compressed

24
Q
  1. Alternative diagnostic agents

b. 1% phenylephrine

A 
normal= minimal dilation
horner's= a lot of dilation due to super sensitive post ganglion
25
Q

efferent

A

leaving CNS (motor) going to eyeball

26
Q

efferent parasympathetic pathway cause- tonic pupil causes

A
  1. autonomic- bilateral, diabetes
  2. orbital mass- unilateral
  3. orbital trauma/surgery - unilateral
  4. idiopathic (adie tonic pupil)
27
Q

direct pupillary light response

A

constriction of ipsilateral eye

28
Q

RAPD optic tract

A

get APD contralateral to the lesion with complete homonymous hemianopia more nasal
-more nasal fibers cross at chiasm –> see on opposite side

29
Q

RAPD grading

grade 1

A

grade 1- weak constriction followed by greater redilation

30
Q

afferent

A

brings info to CNS, ON, retin

31
Q

in efferent parasympathetic pathway is anisocoria better or worse in dim illumination

A

better

32
Q

afferent pathway

A
  1. afferent pathway follows the visual fibers
  2. the fibers leave the optic tract and travel within the brachium of the superior colliculus to the pretectal area of the midbrain
  3. pretectal nucleus (synapse)
  4. fibers travel to the EW nuclei in posterior commissure (central pathway)
33
Q

what will the disruption of the afferent pathway affect

A

disruption of the afferent pathway will affect the direct response of the ipsilateral eye and the consensual response in the contralateral eye

  • RAPD
  • will not cause anisocoria
34
Q

RAPD grading

grade 4

A

no reaction to direct light

35
Q

RAPD chiasm

A

unusual bc fibers are crossing

36
Q

disruption of the efferent sympathetic pathway: Horner’s syndrome

A
  1. miosis
  2. anisocoria greater in dim light
  3. normal reaction to light (direct and consensual is good)
  4. dilation lag - not as quickly
    (more aniso after 15 secs than 5 secs)
  5. ptosis and pseudoenopthalmos (eye appears sunken in due to ptosis + reverse ptosis of lower lid)
  6. facial anhidrosis (absence of sweating–> w/ preganglionic or central problem)
  7. iris heterochromia in congenital horner’s syndrome (melanin is sympathetic system to develop- eye w/ horner’s would be lighter than other eye)
37
Q

RAPD grading

grade 2

A

grade 2- no constriction followed by redilation

38
Q

near pupil response pathway CNS

A

frontal eye fields–> CNS -nucleus EW + MR

39
Q

disruption in the efferent parasympathetic pathway

A

a lesion of the efferent pathway will cause the ipsilateral eye to show poor direct, consensual, and near pupillary responses
(remains ipsi after leaving midbrain)

ipsilateral mydriasis

anisocoria worse in bright light (bad pupil won’t constrict)

40
Q

Disruption of the efferent sympathetic pathway: Horner syndrome
pathway - postganglionic

A

follows ICA plexus –> cav sin –> CN5 (nasociliary nerve) –> long ciliary nerves –> dilator

41
Q

when does light near dissociation occur

A

disruption in the central NS pathway

42
Q

adie tonic pupil

A

mild tonic pupil –> asymptomatic
common- 20-40 yo females
decrease tendon reflexes (via spinal cord)

43
Q

swinging flashlight test

A
  1. dr moves light from one eye to other many times
  2. make sure each pupil is equally illuminated
  3. if no damage, there will be little no change in pupil size
  4. if damage, the ipsilateral pupil will dilate when shining light alternately between the eyes
44
Q

near pupil response pathway

-afferent

A

(visual pathway to the striate cortex)

45
Q
  1. Alternative diagnostic agents
    a. Apraclonidine 0.5 or 1%
    (1) Alpha adrenergic agonist
A
  • normally lowers pressures
  • works on tm, bm, usually no dilation
  • normal= no dilation
  • horner’s= dilation (w/ pre or post)
46
Q

efferent pathway parasympathetic

A

ew nucleus –> through cn3 –> inferior division of cn3 –> synapse in ciliary ganglion –> follows short ciliary nerves –> iris sphincter

47
Q
  1. Localization: 1% hydroxyamphetamine

a. Indirect acting adrenergic agonist

A 
pre= dilation
post= no dilation
48
Q

Disruption of the efferent sympathetic pathway: Horner syndrome
pathway - central

A

hypothalamus –> brainstem –> cervical spinal cord (T1-T2) –>

Visual System Anatomy (10 decks)

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