Pupils Flashcards
What is abnormal anisocoria?
pupil size difference of more than 0.5 mm (look for lid involvement)
What is an amaurotic pupil?
Blind pupil; no DIRECT light reflex
What is Hutchinson’s pupil?
unilateral, fixed, dilated pupil
When does anhydrosis occur in Horner’s Syndrome?
when lesion is before carotid bifurcation and superior cervical ganglion
What is Horner’s syndrome and list three symptoms/effects?
a defect along the sympathetic pathway; ptosis, miosis, and anhydrosis
Where do the first order neurons of the sympathetic pathway extend (to and fro)?
posterior hypothalamus to C8-T2
What are 3 possible causes for first order neuron Horner’s Syndrome?
cerebrovascular accident (stroke), neck trauma, multiple sclerosis
What are 5 possible causes for second order neuron Horner’s Syndrome?
Pancoast’s tumor, Tuberculosis, Metastatic breast cancer, trauma, thyroid neoplasm/surgery
Where do the Second order neurons extend from and to
leave spinal cord, over apex of lungs, synapse in superior cervical ganglion
Third order neurons are post-ganglionic and travel on the internal carotid until the break into what two separate divisions/pathways
nasociliary nerve -> long ciliary nerves -> pupil dilator,
opthalmic artery -> eyelid muscles (levator palpebrae superioris)
What can affect the nasociliary pathway of the 3rd order neurons
internal carotid dissection and aneurysm, and a nasopharyngeal carcinoma
What can affect the opthalmic artery pathway of the 3rd order neurons
Migraines
Is Horner’s Syndrome in children benign or malignant when it is congenital
benign (brachial plexus injury during birth) but need to rule out a neuroblastoma in sympathetic chain of chest/neck (acquired Horner’s may also be due to a neuroblastoma)
When is light-near dissociation diagnostically valuable
if the direct light reflex is absent or abnormal
What is the light-near dissociation phenomenon
when response to accommodation is stronger than light response (accommodation fibers out number pupil fibers 30:1)
In patients with anisocoria when is a dilated pupil more noticeable and when is a miotic pupil more noticeable
dilated in illumination (sphincter muscle not working well)
miotic in the dark (dilator muscle not working well)
List 4 disorders of the para-sympathetic system
trauma, adie’s tonic pupil, third nerve palsy, hutchinson’s pupil
What is Adie’s Tonic Pupil
unilaterally dilated pupil with poor reaction to light and slow tonic re-dilation
What is Adie’s tonic pupil due to
a denervated ciliary ganglion (sectoral palsy of the iris sphincter)
At what rate does the Adie’s tonic pupil become bilateral
(most cases - 80% unilateral), becomes bilateral at 4% per year
What symptoms/issues are present with Argyll-Robertson pupils
both pupils are constricted, dilate poorly, respond poorly to dilating agents
When is Argyll-Robertson’s commonly seen
in patients with syphilis, diabetes, chronic alcoholism, multiple sclerosis, and sarcoidosis
When do you check for accommodative response
only if direct light response is abnormal or absent
When is an afferent pathway defect detected (APD)
during “swinging flashlight test”
Can an eye with normal visual fields and 20/20 acuity have an APD
YES
