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Pupils > Pupils > Flashcards

Pupils Flashcards

1
Q

The iris sphincter muscle encircles the pupil and _ the pupil which is known as _

A

Constricts, miosis

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2
Q

The iris dilator radial muscle _ the pupil which is known as _

A

Dilates, mydriasis

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3
Q

The sphincter muscle is innervated by the _ nervous system through _ with the neurotransmitter _

A

Parasympathetic, CNll , acetylcholine

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4
Q

The dilator muscle is innervated by the _ nervous system through _ with the neurotransmitter _ and _

A

Sympathetic , CNV , epinephrine, norepinephrine

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5
Q

Light traveling from the eye to the brain is called _ pathway and is responsible for the _ response

A

Afferent , direct

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6
Q

Light traveling from the brain to the iris sphincter is called the _ pathway and is responsible for the _ response which is equally distributed to each eye.

A

Efferent, consensual

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7
Q

The near reflex consists of _ , _ and _

A

Accommodation, covergence and pupil constriction

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8
Q

The afferent pupillary pathway

A 
Ganglion cells in the retina 
Optic nerve 
Optic chiasm 
Optic tracts 
Pretectal nuclei in midbrain 
Posterior commissure crossing 
Edinger-westphal nuclei (part of CN3 nuclei )
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9
Q

Afferent pupillary defects can include

A 
Large retinal lesion
Optic nerve disease 
Optic nerve compression 
Optic tract lesion 
Midbrain lesion
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10
Q

Fibers along the surface of CN3 travel next to the _ and are exposed to forces of herniation

A

Posterior communicating artery

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11
Q

Efferent parasympathetic response pathway

A 
Edinger Westphal nuclei 
Oculormotor CN3
Ciliary ganglion 
Short posterior ciliary nerves 
Choroid, iris sphincter and ciliary body
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12
Q

Efferent sympathetic response pathway

A 
1. Order neuron 
Hypothalamus 
synapse C8-T2 in spinal cord 
2. Order neuron 
Exit spinal cord 
Superior cervical ganglion 
3. Order neuron 
CNV nasociliary branch 
Long ciliary nerves 
Dilator muscle, mueller muscle, and frontal sweat glands
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13
Q

When evaluating the pupils the patient should be directed to view a _ target at distance such as a small light. Pupil _ is generally measured in a _ room and should be _ in size

A

Non accommodation, size , dark , equal

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14
Q

Normal average pupil size ranges are in the light _ and in the dark _

A

2-4 mm , 4-8 mm

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15
Q

Patient with _ pupils after LASIK may have impaired night vision such as _, _, and _

A

Large, starburst, halos , ghost images

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16
Q

If a patient has anisocoria (unequal pupil size) the pupil should be measured in _

A

Light and dark

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17
Q

Pupil _ should be evaluated with normal being _ and _

A

Shape , round , centered

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18
Q

The pupil _ should be tested evaluating both the _ and _ response

A

Reaction to light , direct, consensual

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19
Q

Direct pupil response _

A

Constriction of the pupil light is shone

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20
Q

Consensual response _

A

Constriction of un-illuminated pupil

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21
Q

The swinging flashlight test is done to check an _ which is known as _

A

Relative afferent pupil (RAPD) Narcus -Gunn pupil

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22
Q

The pupils response to _ should also be measured and recorded if there is an abnormal light response

A

Accommodation

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23
Q

When a patient looks from a distance non accommodative target to near (20/40) accommodative target normal pupils with both _

A

Constrict

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24
Q

Afferent accommodate pathway is the same as the afferent _ pathway for image analysis

A

Visual

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25
Q

_ pathway differs from light pupillary pathway

A

Accommodative

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26
Q

Accommodative efferent pathway

A 
Visual cortex,
prefrontal cortex
oculomotor nucleus and Edinger -westphal nucleus 
oculomotor nerve goes to medial rectus muscle (convergence 
 part of the near reflex) 
Ciliary ganglion 
Short posterior ciliary nerves 
Iris sphincter and ciliary muscle
27
Q

The accommodative pathway differs from the light pathway in that fibers skip the _ which is called _

A

Pretectal nucleus in midbrain , light near dissociation

28
Q

The normal pupil response to light occurs when light is shone in one eye causes _ , equal constriction of _ pupils. Shine light in eye _.

A

Brisk(fast) , both, 2-3 sec

29
Q

_ is spasmodic, rhythmic dilating and contracting pupillary movements which are usually normal

A

Hippus

30
Q

Dilating drops simulate or inhibit receptor and have _ bottle tops.
Sympathetic stimulator _

A

Red, drives dilator muscle contraction

Drop: phenylephrine 2.5% -10% ( neosynephrine)

31
Q

Parasympathetic inhibitor _

A

Prevents sphincter constricting
Drops: tropicamide 0.5-1% (mydriacyl)
Cyclopentolate, atropine , homatropine , scopolamine

32
Q

_ is unequal pupil size between eye

A

Anisocoria

33
Q

Localize anisocoria by pupil response

A
34
Q

Asymmetry equal in light and dark

A

Physiologic or simple anisocoria

35
Q

Asymmetry greater in dark

A

One pupil cannot dilate sympathetic nervous system defect

36
Q

Asymmetry greater in light

A

One pupil cannot constrict parasympathetic (nervous system) defect

37
Q

Anisocoria normal light reaction

A

Physiologic

Horner’s syndrome

38
Q

Anisocoria abnormal light reaction

A

Adie’s tonic
3rd nerve palsy
Pharmacologic
Iris sphincter damage

39
Q

Constricted pupil anomalies

A 
Horner’s syndrome 
Argyll Robertson pupil 
Iritis 
Corneal irritation 
Pharmaceutical 
Street drugs
40
Q

Horner’s syndrome is from lack of _ innervation, it’s signs including _ dilator muscle not being stimulated from SNS so Anisocoria worse in dark _ slight loss of lid elevation from muellers muscle not being stimulated from
SNS

A

Sympathetic, miosis , ptosis

41
Q

_ loss of facial sweat from sweat glands not being stimulated from SNS

A

Anhydrosis

42
Q

Pharmaceutical testing for Horner’s includes

A
43
Q

_ prevents reuptake of norepinephrine from dilator muscle synapse flooding it. Normal eye will dilate and Horner’s eye does not dilate as the SNS block does not allow the release of norepinephrine in the first place.

A

Cocaine 10%

44
Q

_ Normal eye does not change in size and horners eye will dilate with reduction of ptosis

A

Apraclonidine (0.5%) (iopidine)

45
Q

_ stimulates intact SNS nerve to release norepinephrine to dilator muscle. I’d Horner’s eye dilates this rules out 3rd order neuron problem pointing to 1st and 2nd order neuron problem

A

Hydroxyamphetamine

46
Q

Horner’s syndrome post ganglionic 3rd order neuron problems can include: ___ dissection (splitting apart) of blood within wall often from injury such as whiplash that can lead to stroke from carotid occlusion or clot. _ neck dissection _

A

Carotid artery damage, post surgical , cavernous sinus tumor

47
Q

Horner’s 2nd order neuron lesion can include __ ( beware of Horner’s in smokers) __ sentinel nodes in neck __ aortic aneurysm, brachial plexus syndrome, surgery

A

Apical lung cancer , metastasis, check lesion

48
Q

Horner’s 1st order neuron lesion can include: _

A

Brain and spinal cord-stroke , tumor

49
Q

Congenital horner’s can be associated with _ or _

A

Retinoblastoma, heterochromia

50
Q

Horner’s pupil responses are

A

Direct response in affected eye
Consensual response in affected eye
Increased accommodative response

51
Q

__ is often from CNS syphilis and presents with bilateral pupil constriction unequal in size and irregular in shape. The pupils won’t dilate with atropine.

A

Argyll Robertson pupils
No direct response in affected eye
No consensual response in affected eye
Good accommodative response (light-near dissociation)

52
Q

_ is inflammation that causes iris edema constricting the pupil

A

Iritis

53
Q

_ from foreign body or trichiasis can construct the pupil

A

Corneal irritation

54
Q

Constricting drop used for the treatment of _ can construct the pupil and include :

A

Glaucoma , pilocarpine , carbachol

55
Q

Other substance that can constrict the pupils are

A

Alcohol

Opioids

56
Q

A fixed non reactive pupil _

A

Can be very dangerous

57
Q

Anisocoria worse in light is due to lack of _ innervation to sphincter muscle so pupil won’t constrict

A

Parasympathetic

58
Q

aneurysm of the posterior communicating artery can compress the CN3 fibers causing the pupil to dilate, and if ruptures can cause _ or _

A

death or severe neurological damage

59
Q

3rd ( oculomotor) nerve palsy signs can include

A

dilated pupil that has poor or no reaction directly or consensual or accommodative , ptosis
tropia- eye down & out

60
Q

adies tonic pupil can be from

A

PNS lesion @ cilary ganglion or post viral more predominate in women 20-40

61
Q

3rd nerve palsy can be from

A

slow contraction to light directly and consensually ( contracts in segments)
slow re-dilation
normal accomodative pupil contriction

62
Q

pharmaceutical testing for adies pupil shows sensitivity to _ where _ constricts adies pupil but not normal pupil

A

acetylcholine , -pilocarphine .12%

63
Q

mydriatics or cycloplegics

A

red top bottles

64
Q

__ is a blind eye that is caused from defects in fibers in the ON proximal to the chiasm. The pupil responses of an amaurotic pupil reveak a total afferent pupillary defect (TAPD) versus a relative defect where some vision may be possible.

A 
Amaurotic pupil 
no direct response if affected eye
non consensual response in non-affected eye
direct response in non -affected eye 
consenual response in affected eye

Pupils (1 decks)

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