The pupil

Question 1

Features of Holmes-Adie pupil

Answer 1

initially unilateral then bilateral dilated pupils w. delayed reaction to accommodation reflex and especially to the light reflex. there is also delayed re-dilatation.

Question 2

Tonic pupil differential Dx (7)

Answer 2

migraine
syphilis
VZV
DM
sarcoid
arteritis
MG

Question 3

Presentation of Holmes-Adie pupil (4)

Answer 3

often young woman 
sudden blurring of near vision
dilated pupil
slow accommodation and light reflexes 
(benign condition)

Question 4

Ix for Holmes-Adie pupil (2)

Answer 4

slit lamp shows spontaneous wormy movements of iris

dilute pilocarpine should constrict abnormal pupil not the normal one.

Question 5

Features and cause of Holmes-Adie syndrome (6)

Answer 5

tonic pupil
absent knee/ankle jerks
autonomic dysfunction w. disturbed vasomotor and sweating
hypotension
cough
caused by damage to post-ganglionic fibres of parasympathetic innervation to eye (III) by bacterial or viral infection.

Question 6

Horner’s (4)

Answer 6

ptosis
meiosis
anhydrosis
enopthalmos

Question 7

Causes of Horner’s syndrome (8)

Answer 7

PICA/basilar artery occlusion
MS
cavernous sinus thrombosis
pancoast's tumour
hypothalamic lesions
cervical adenopathy
mediastinal masses
pontine syringomyelia

Question 8

Ix for horner’s

Answer 8

4% cocaine eyedrops>dilatation in normal eye.

Question 9

Argyll-Robertson pupil features and causes (5)

Answer 9

bilaterally constricted pupils
no reaction to light
accommodation preserved
caused by neurosyphilis or DM