Pupil Evaluations

Question 1

Pupils can be evaluated on a scale of __ to __

Answer 1

0 to 4 (2 and 3 are gradients in between. 0 means there was no reaction, NLP. 4 is a fast and crisp reaction)

Question 2

A fast, crisp construction of the pupil can be recorded as

Answer 2

4+ or 4

Question 3

Corectopia

Answer 3

A misplaced pupil. Not centered. Either developmental or trauma (trauma is more likely).

Question 4

Anisocoria

Answer 4

Unequal pupil size

Question 5

Miotic

Answer 5

Small, constructed pupil. This can also be a drug classification that constructs the pupil. Not very common.

Question 6

Mydriatic

Answer 6

A drug classification that dilates the pupil. Paralyzation of spinster activation of dilator. Paralyzation of spinster activation of dilator.

Question 7

Direct light reflex

Answer 7

The constriction of the pupil to light, as observed in the illuminated eye.

Question 8

Consensual light reflex

Answer 8

The constriction of the pupil to light, as observed in the fellow eye.

Question 9

Sphinctor muscle

Answer 9

One of the iris muscles, responsible for constriction (parasympathetic innervation)

Question 10

Dilator muscle

Answer 10

One of the iris muscles, responsible for dilation (sympathetic innervation) Fight or flight- take in lots of light.

Question 11

Accommodative/near reflex

Answer 11

The constriction of the pupil in response to accommodation or a near stimulus. Not normally done, Add on if something abnormal is found.

Question 12

Marcus gunn reflex

Answer 12

Paradoxical (seemingly absurd) dilation to a bright light, a sign of optic nerve disease. Relative. Afferent pupillary defect. (Relative)APT.

Question 13

Pupillary pathway

Answer 13

Optic nerve to the optic tract.
Optic tract to the pretectal nucleus (mid brain) where they synapse. Here, they send epsilateral and contralateral fibers.

The fibers then cross and go to the edinger westphal nuclei.
From Edinger westphal nuclei to cranial nerve III.
The fibers then go to the ciliary ganglion where they synapse.
After the synapse, they go to the inferior branch of CN III, then onto the sphincter.

Question 14

Criteria when setting up for an anisocoria check

Answer 14

Dim lighting

Patient fixation at distant target- large E or muscle light.

Question 15

Amaurotic pupil

Answer 15

Manifested in an eye with no light perception
NLP
Eyeball= off
connection= eye

Question 16

What happens when you do direct and consensual responses on a patient with an amaurotic pupil

Answer 16

No direct response in the blind eye (NLP)
No consensual response in the good eye

Direct response in the good eye
Consensual response in the blind eye

Positive APD in the blind eye. 0

Question 17

Argyll-Robertson Pupil

Answer 17

Prostitute pupils

Small, irregular pupils, which do not react to light, but do have a positive accommodation response.

Main cause is CNS syphilis, but can also be caused by diabetes, alcoholism, and mid-brain tumors.

Question 18

Aide’s tonic pupil

Answer 18

Aide’s for the ladies. Tonic- pupils do not like to move. A benign condition, where the affected pupil is dilated in bright illumination. The pupil shows no immediate response to bright light, but may eventually show some construction with sustained exposure. Slow. Stuck.

This condition is usually unilateral and begins during the 3rd to 5th decade of life.

Question 19

What happens when you do direct and consensual response on aide’s tonic pupil?

Answer 19

Shine light in the bad eye and it will take some time for that pupil to constrict, but eventually, it will. Good eye will have a quick consensual response.

Question 20

Horners triad

Answer 20

Ptosis (droopy lid)
Miosis (small pupil)
and anhydrosis (no sweating)
All of these only occur on the affected side.

A variety of vascular, traumatic, or neoplastic lesions interruprt the oculosympathetic pathway to CN III.

A horners pupil will not dilate quickly after bright light exposure.. will take longer for it to re-dilate after light is shined into the eye and then removed.

MUST REFER. Possible lung tumor

Question 21

Marcus-Gunn pupil

Answer 21

Poorer direct response than consensual response in the affected eye. The afferent pupil defect is a sign of optic nerve/neural disfunction.

If light is directed into the diseased eye, it is like the patient going into a dark room= pupils dilates.