Pupils

Question 1

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

Answer 1

Constricts, miosis

Question 2

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

Answer 2

Dilates, mydriasis

Question 3

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

Answer 3

Parasympathetic, CNll , acetylcholine

Question 4

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

Answer 4

Sympathetic , CNV , epinephrine, norepinephrine

Question 5

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

Answer 5

Afferent , direct

Question 6

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.

Answer 6

Efferent, consensual

Question 7

The near reflex consists of _ , _ and _

Answer 7

Accommodation, covergence and pupil constriction

Question 8

The afferent pupillary pathway

Answer 8

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 )

Question 9

Afferent pupillary defects can include

Answer 9

Large retinal lesion
Optic nerve disease 
Optic nerve compression 
Optic tract lesion 
Midbrain lesion

Question 10

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

Answer 10

Posterior communicating artery

Question 11

Efferent parasympathetic response pathway

Answer 11

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

Question 12

Efferent sympathetic response pathway

Answer 12

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

Question 13

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

Answer 13

Non accommodation, size , dark , equal

Question 14

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

Answer 14

2-4 mm , 4-8 mm

Question 15

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

Answer 15

Large, starburst, halos , ghost images

Question 16

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

Answer 16

Light and dark

Question 17

Pupil _ should be evaluated with normal being _ and _

Answer 17

Shape , round , centered

Question 18

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

Answer 18

Reaction to light , direct, consensual

Question 19

Direct pupil response _

Answer 19

Constriction of the pupil light is shone

Question 20

Consensual response _

Answer 20

Constriction of un-illuminated pupil

Question 21

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

Answer 21

Relative afferent pupil (RAPD) Narcus -Gunn pupil

Question 22

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

Answer 22

Accommodation

Question 23

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

Answer 23

Constrict

Question 24

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

Answer 24

Visual

Question 25

_ pathway differs from light pupillary pathway

Answer 25

Accommodative

Question 26

Accommodative efferent pathway

Answer 26

``` 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 ```

Question 27

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

Answer 27

Pretectal nucleus in midbrain , light near dissociation

Question 28

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

Answer 28

Brisk(fast) , both, 2-3 sec

Question 29

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

Answer 29

Hippus

Question 30

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

Answer 30

Red, drives dilator muscle contraction | Drop: phenylephrine 2.5% -10% ( neosynephrine)

Question 31

Parasympathetic inhibitor _

Answer 31

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

Question 32

_ is unequal pupil size between eye

Answer 32

Anisocoria

Question 33

Localize anisocoria by pupil response

Question 34

Asymmetry equal in light and dark

Answer 34

Physiologic or simple anisocoria

Question 35

Asymmetry greater in dark

Answer 35

One pupil cannot dilate sympathetic nervous system defect

Question 36

Asymmetry greater in light

Answer 36

One pupil cannot constrict parasympathetic (nervous system) defect

Question 37

Anisocoria normal light reaction

Answer 37

Physiologic | Horner’s syndrome

Question 38

Anisocoria abnormal light reaction

Answer 38

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

Question 39

Constricted pupil anomalies

Answer 39

``` Horner’s syndrome Argyll Robertson pupil Iritis Corneal irritation Pharmaceutical Street drugs ```

Question 40

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

Answer 40

Sympathetic, miosis , ptosis

Question 41

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

Answer 41

Anhydrosis

Question 42

Pharmaceutical testing for Horner’s includes

Question 43

_ 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.

Answer 43

Cocaine 10%

Question 44

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

Answer 44

Apraclonidine (0.5%) (iopidine)

Question 45

_ 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

Answer 45

Hydroxyamphetamine

Question 46

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 _

Answer 46

Carotid artery damage, post surgical , cavernous sinus tumor

Question 47

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

Answer 47

Apical lung cancer , metastasis, check lesion

Question 48

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

Answer 48

Brain and spinal cord-stroke , tumor

Question 49

Congenital horner’s can be associated with _ or _

Answer 49

Retinoblastoma, heterochromia

Question 50

Horner’s pupil responses are

Answer 50

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

Question 51

__ 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.

Answer 51

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

Question 52

_ is inflammation that causes iris edema constricting the pupil

Answer 52

Iritis

Question 53

_ from foreign body or trichiasis can construct the pupil

Answer 53

Corneal irritation

Question 54

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

Answer 54

Glaucoma , pilocarpine , carbachol

Question 55

Other substance that can constrict the pupils are

Answer 55

Alcohol | Opioids

Question 56

A fixed non reactive pupil _

Answer 56

Can be very dangerous

Question 57

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

Answer 57

Parasympathetic

Question 58

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

Answer 58

death or severe neurological damage

Question 59

3rd ( oculomotor) nerve palsy signs can include

Answer 59

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

Question 60

adies tonic pupil can be from

Answer 60

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

Question 61

3rd nerve palsy can be from

Answer 61

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

Question 62

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

Answer 62

acetylcholine , -pilocarphine .12%

Question 63

mydriatics or cycloplegics

Answer 63

red top bottles

Question 64

__ 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.

Answer 64

``` 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 ```