Pupils

Question 1

Miosis:

What is it?

Argyll Robertson Pupil:

• What is this?
• What can they do?
• What can they not do?
• What is a weird cause of this?

Answer 1

Bilateral miosis

They can accommodate - pupils reduce in size

Lack of pupillary constriction due to light

Neurosyphilis

Question 2

Horner’s syndrome:

What is it?

4 symptoms?

Answer 2

A combination of signs and symptoms caused by the disruption of a nerve pathway from the brain to the face and eye on one side of the body.

Unilateral:

• Miosis
• Ptosis
• Anhidrosis
• Enophthalmos

Question 3

Horner’s syndrome:

CNS causes? - 3

Peripheral lesions between T1 and ciliary ganglion can cause it. What can cause these lesions?

When do you get anhidrosis, before or after the ciliary ganglion?

What peripheral lesions can happen after the ciliary lesions?

Answer 3

Stroke
Space-occupying lesions
MS

TB
Abscess
Trauma

Before ciliary ganglion

Carotid artery dissection
Cluster headaches

Question 4

Bilateral pinpoint pupils causes:

Where would a haemorrhagic stroke be to cause this?

What drug would cause this?

Answer 4

Pontine haemorrhagic stroke

Opioid toxicity

Question 5

Mydriasis - Holmes-Adie syndrome:

Another name for the pupil?

What is it?

Does the pupil react to light?

What else is associated with this?

What is damaged which results in this

Answer 5

Tonic pupil

The dilated pupil which reacts minimally to light

Sweating abnormality
Hyporeflexia

Parasympathetic denervation resulting from ciliary ganglion damage (CN 3 no longer able to constrict pupil)

Question 6

Mydriasis - Fixed dilated pupil:

CN3 compression causes this. What could it be?

Bilateral cause that is an emergency

Answer 6

Intracranial haemorrhage
Posterior communicating artery aneurysm
Tumour

Coning, causing brainstem compression

Question 7

Mydriasis:

What antidepressant can cause this?

What illicit drug can cause this?

Answer 7

TCA

Cocaine