Pupils - Lynch Flashcards
Afferent Pupil
Releative Afferent Pupil Defect (RAPD) if defect in the “in” information
CN 2 (Optic Nerve)
Efferent Pupil
Anisocoria (unequal pupils) if defect is in the “out” signal
CN 3
Parasympathetic constricts
Sympathetic dilates
Near Triad
Miosis
Convergence
Accomodation
Pupillary Responses
Direct
Consensual
Accomodative
Relative Afferent Pupillary Defect (RAPD)
Marcus-Gun Pupil
objective measure of the afferent light input of one eye compared to the other
signifies asymmetric pre-geniculate damage - examples: retinal lesions, ispsilateral optic nerve, optic tract
tested by Swinging Flashlight Test
no anioscoria, not due to cataracts or corneal opacity
In an abnormally large pupil anisocoria is greatest in ____________?
In an abnormally small pupil - anisocoria is greatest in ____________?
abnormally large pupil - anisocoria greatest in light
abnormally small pupil - anisocoria greatest in dark
Identify this condition and describe the treatment and management:
abnormally large pupil, vermiform movement of iris, sgemental/sector sphincter palsy
Adie’s Pupil
etiology: infection, inflammation, ischemia, local anesthesia, surgery, laser, trauma, autonomic
tonic pupil causes: diabetes, chronic alcoholism, encephalitis
treatment: increase biofocal strength, pilocarpine
Identify this condition and describe the treatment and management:
absent deep tendon reflexes, hyperthermia, syncopal episodes, dysgeusia, chronic GI motlity, tonic pupils
Adie’s Syndrome
refer for a neurology consult
Pharmacologic Mydriasis
large dilated pupil
does not react to light or near
does not react well to miotics
exposure to :
- dilating drops
- parsympatholytic agents (Atropine, Asthma medicine)
- plants (Belladonna, Jimson Weed)
- pesticides
Cranial Nerve III Palsy
Associated with ptosis +/- EOM abnormality
Pupil involving a third nerve palsy - is an anerusym until proven otherwise
Causes: PCA aneurysm, trauma, brain tumor, microvascular ischemia
Isolated dilated pupil - not likely to be thrid nerve palsy
Pharmacologic Miosis
small pupil - poor reaction to light and near stimuli
exposure to:
- acetycholinesterases
- tick and flea collars
- pilocarpine and topical parasympathomimetics
Aberrent Reinnervation
third nerve palsy with smaller pupil
does NOT react well to light
light-near disocciation
clincial features: unilateral miosis which accompanies eye movement may also have lid elevation/retraction with eye movement
Horner’s Syndrome Symptoms
Ptosis
Miosis
Anhydrosis
Etiology of Horner’s Syndrome
Congenital - affected eye may be lighter, likely from birth trauma
Acquired - cartoid dissection, carotid aneurysm, apical lung tumor (Pancoast tumor), occult neuroblastoma
Pharmacologic Diagnosis of Horner’s Syndrome
Cocaine Testing - confirms - nothing enstilled in eye before, Horner’s pupil dilates less than normal one
Apraclonidine - little or no effect on a normal pupil
Localization of Horner’s Syndrome - Hydroxyamphetamine Testing: done 48 hours after cocaine test
