Term
| What does pupil testing check for? |
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Definition
-integrity and function of: iris, optic nerve, and visual pathways
-CN3 para- and sympathetic pathway |
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Term
| A patient has abnormal reflex to light. Is this an afferent or efferent defect? |
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Definition
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Term
| A Px has anisocoria. Is this afferent or efferent pupillary defect? |
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Definition
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Term
| Where do the sphincter neuro-fibres arise from? |
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Definition
-short ciliary nerves
-EW nucleus |
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Term
| Where do the dilator neuro-fibers arise from? |
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Definition
-long ciliary nerves
-fibres arise from superior cervical ganglion |
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Term
| You shine light in a Px eyes and notice a defect. What are possible causes? |
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Definition
-local iris restriction
-afferent tract
-midbrain
-efferent tract problems |
|
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Term
| Which parts of visual system are likely to be affected in an afferent defect? |
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Definition
| -retina and ON (more common) |
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Term
| What features would you suspect to see in Absolute Afferent Pupillary defect in one eye? |
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Definition
-no light perception in eye
-pupils equal
-no direct reflex and no consensual reflex in opposite eye
-normal direct in opposite eye and normal consensual in involved eye
-near reflex is normal in each eye |
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Term
| What features would you expect to see in RAPD? |
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Definition
-both pupils dilate when abnormal eye is stimulated
-consensual response is greater than direct
-affected eye responds as if light is dimmer |
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Term
|
Definition
-amplyopia
-vitreous haemorrhage
-macular degen
-BRVO/CRVO
-retinal detachment
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|
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Term
|
Definition
-Optic nerve disease
-ischemia CRVO/CRAO
-optic chiasmal legion? |
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Term
| What signs would you expect to see in RAPD? |
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Definition
-reduced acuity
-colour vision defects
-central visual field defects
-abnormal VEP |
|
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Term
| What features do you expect to see in light-near dissociation? |
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Definition
-absent or sluggish light reflexes
-normal near response |
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Term
| What condition would you suspect with a Px would comes in does not respond well to mydriatics, pupils small and irregular in shape and see a light near dissociation (poor reaction to light) |
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Definition
| -Argyll Robertson Pupil (also likely bilateral with interstitial keratitis through slit lamp) |
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Term
|
Definition
-unequal pupil size
-may indicated efferent (motor lesion)
- abnormal pupil may be larger or smaller one |
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Term
| After doing a near convergence test you notice a Px has slow tonic redilation as Px shifts gaze from near to far. What condition is this called? |
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Definition
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Term
| What is adies' tonic pupil? |
|
Definition
-unilateral, irregular, slightly dilated pupil
-reacts minimally to light, and slowly to convergence and accommodation
-mainly young women (80%)
-unilateral blurred vision due to reduced accomodation |
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Term
| What is the pathology of Adie's tonic pupil |
|
Definition
-damage to ciliary ganglion or postganglionic parasympathetic fibres
-possible supersensitivity of one eye to cholinergic agents
-parasympathetic efferent defect |
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Term
| What is Tournay's Phenomenon? |
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Definition
| -Lateral gaze induces an enlarged pupil in abducting eye |
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Term
| What is the neurological reason for Tournay's phenomenon? |
|
Definition
-co-innervation of the MR & iris sphincter
-anamolous innervation of sphincter by neurons intended for ipsilateral MR |
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Term
| What are the causes of anisocoria when the abnormal pupil constricted? |
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Definition
-unilateral use of a miotic
-argyll robertson pupil
-iritis
-horner's syndrome
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|
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Term
| What are causes of anisocoria when the abnormal pupil is dilated? |
|
Definition
-unilateral use of mydriatic
-iris sphincter damage
-tonic pupil (adie's)
-CN3 palsy |
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Term
| A Px presents with a bit of ptosis and miosis and anhidrosis on ipsilateral side. What might you suspect? |
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Definition
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Term
| Upon removing light from Px's eye you notice a lag in dilation. What is this pathognomonic for? |
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Definition
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Term
| Px comes in what appears like horner's syndrome and Sxs of arm pain. What might you suspect? |
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Definition
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Term
| You use 1% hydroxyamphetamine on a Px with horner's and see dilation in the affected eye. Where would you suspect the lesion to be? |
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Definition
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Term
| What kind of exam would request if you saw pupil involvment in a third nerve palsy? |
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Definition
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Term
| What is a hutchinson pupil? |
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Definition
-pupil response due to a lesion impacting the third nerve. (head injury, stroke, brain tumor, absess and edema)
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Term
| Which drugs would you use to test small (miotic) pupils? |
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Definition
-cocaine
-hydroxyamphetamine
-mydriatics |
|
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Term
| Which drugs would you use to test large dilated pupils? |
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Definition
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Term
| What are classic pupil reflex abnormalities? |
|
Definition
-anisocoria
-pharmacological pupil
marcus gunn pupil |
|
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Term
| What are classic miotic pupil anamolies? |
|
Definition
-Horner's Syndrome
-Argyll Robertson pupil
|
|
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Term
| What are classic dilated pupil anomalies? |
|
Definition
-Adie's tonic pupil
-sphincter damage
-IIIrd Nerve Palsy (Hutchinson pupil) |
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Term
| What causes pupils to constrict? |
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Definition
| -direct, consensual and near stimulation |
|
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Term
|
Definition
| -unequal pupil sizes usually do to a motor lesion (efferent) |
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Term
| An abnormal pupil response indicates what possibilities? |
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Definition
| -afferent or efferent defect, midbrain defect, or iris defect |
|
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Term
| Which defect affects the sensory part of system, retina or optic nerve and you will find equal pupils? |
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Definition
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Term
| What is known as an amaurotic pupil? |
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Definition
-absolute afferent pupillary defect
-normal near reflex |
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Term
| Both pupils dilate when abnormal eye is stimulated but you also notice the consensual is greater than the direct. Affected eye responds as though light is dimmer. What is this and what does is usually mean? |
|
Definition
-RAPD
-generally indicated presence of an optic nerve conduction defect |
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Term
| What is a damaged ciliary ganglion, dilated pupil that reacts poorly to light and accommodation, often distorted shape and is supersensitive to cholinergic agents (pilocarpine). Causes? |
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Definition
-post ganglionic lesion (causes anisocoria)
-tonic pupil
-trauma, infectious (herpes), diabetes |
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Term
| You instill mydriatics and note poor dilation in one eye. What might be defect? |
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Definition
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