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opthalmology > pupil disorders > Flashcards

pupil disorders Flashcards

1
Q

what can cause abnormal pupil shape?

A

TRAUMA to sphincter muscles
anterior uveitis
AACG
rubeosis iridis
colobama
tadpole pupil

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2
Q

how can trauma to sphincter muscle cause abnormal shape?

A

sphincter muscle is within iris
can be from cataract surgery

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3
Q

what is anterior uveitis?

A

adhesions - scar tissue within iris
causing irregular pupil shape

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4
Q

how can AACG cause irregular shape?

A

ischaemic damage to muscles of iris and abnormal pupil shape

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5
Q

what is rubeosis iridis?

A

neovascularisation of iris and can distort shape of iris/ pupil

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6
Q

what is colobama?

A

congenital malformation that can cause a hole in iris and irregular pupil shape

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7
Q

what is tadpole pupil?

A

muscle spasm in part of dilator or iris - misshapen pupil

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8
Q

what is tadpole pupil associated with?

A

migraines and horners

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9
Q

what is mydriasis?

A

dilated pupil

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10
Q

what can cause mydriasis?

A

congenital
stimulants - cocaine
anticholinergics - oxybutinin
trauma
third nerve palsy
holmes - adie syndrome
raised ICP
AACG

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11
Q

what is holmes-adie syndrome?

A

rare neuro condition
pupil remains relatively dilated and does not react to light

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12
Q

what is miosis?

A

pupil constriction

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13
Q

what can cause miosis?

A

horner syndrome
opiates
nicotine
pilocarpine
cluster headaches
argyll-roberston pupil

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14
Q

what is argyll roberston pupil?

A

neurosyphilis
remain small and do not react to light

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15
Q

what features are seen in third nerve palsy?

A

ptosis
dilated non-reactive pupil
divergent strabimus

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16
Q

what is ptosis?

A

drooping of eyelid

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17
Q

what is divergent strabismus?

A

squint in affected eye
gives down and out appearance

18
Q

which cranial nerve is the 3rd?

A

occolumotor

19
Q

what does the CNIII supply?

A

all extraoccular except lateral rectus and superior oblique

20
Q

how do you assess CNIII?

A

do 2,3,4,6 together
light reflex
H test
looking distance and back to finger

21
Q

why does third nerve palsy cause eyelid drooping (ptosis)?

A

CNIII also supplies levator palpedbrae superiosis
this is resposible for lifting eyelid

22
Q

what nervous system does CNIII supply?

A

parasympathetic - rest and digest

23
Q

why does third nerve palsy cause dilated and non-reactive pupil?

A

CNIII supplies parasympathetic to circular muscles of iris

24
Q

what can cause typical third nerve palsy?

A

idiopathic

25
Q

what could cause third nerve palsy without affecting pupil be caused by?

A

microvascular cause
parasympathetic fibres are spared
- diabetes
HTN
- ischaemia

26
Q

what causes a full third nerve palsy?

A

compression of nerve
including compression of parasympathetic fibres
- trauma
- tumour
- cavernous sinus thrombosis
- posterior communicating artery aneurysm
- raised ICP

27
Q

what is cavernous sinus thrombosis?

A

blood clot within this sinus
sinus located behind eye socket

28
Q

why can posterior communicating artery aneurysm cause full third nerve palsy?

A

CNIII travels directly from brainstem in a straght line very close to PCA - a aneurysm would push it

29
Q

why can a cavernous sinus thrombosis cause full third nerve palsy?

A

CNIII travles directly from brainstem to eye in a straght line
- blood clot would push against it as the nerve travels through the sinus

30
Q

what is the horner syndrome triad?

A

ptosis - drooping eyelid
miosis - pupil constriction
anhidrosis - loss of sweating

31
Q

what sign may also be seen within horners?

A

enophthalomas
sunken eye
light and accomodation reflexes not affected

32
Q

what causes horner syndrome?

A

damage to sympathetic chain

33
Q

what type of ganglion nerve are the ones affected within horners?

A

pre-ganglion - enter from spinal cord at base of neck

34
Q

how can the location of lesion be determined by horner symptoms?

A

anhidrosis location:
arm, trunk and face - central lesions
face - pre ganglionic
no anhidrosis - post ganglion

35
Q

what are the underlying pathologies for horners? - pre ganglion

A

4S, 4T
4S: central lesions - Stroke, mS, Swelling (tumours), Syringomyelia (cyst in spinal cord)
T: pre ganglionic - Tumour (pancoast), Trauma, Thyroidectomy, Top rib (cervical rib growing above first rib)

36
Q

what is the underlying pathology for post ganglion horners?

A

4Cs
carotid aneurysm
carotid artery dissection
cavernous sinus thrombosis
cluster headache

37
Q

what is congenital horner syndrome associated with?

A

heterochromia - difference in colour on affected side

38
Q

how can you test for horner syndrome?

A

cocaine eye drops
low dose adrenaline eye drops will dilate pupil in Horner syndrome

39
Q

what is Holmes-addie syndrome?

A

holmes addie pupil associated with absent ankle and knee reflexes
damage to post-ganglion fibres

40
Q
A

opthalmology (12 decks)

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