- .The pretectal nucleus sends information to Edinger-Westphal nucleus on both sides - .Both pupils constrict! - .Synapse at the ciliary ganglion - .The signal travels via CN III back to eye - .End destination is the iris sphincter -put these in the correct order

1. The pretectal nucleus sends information to Edinger-Westphal nucleus on both sides 2. The signal travels via CN III back to eye 3. Synapse at the ciliary ganglion 4. End destination is the iris sphincter 5. Both pupils constrict!

Lecture 5 pupils Flashcards by michelle silva

Normal pupils are (equal/unequal) members of a team

equal

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The pupil control system is so important it has (two/three) “managers”

two

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occurence of two simultaneous movements associated with one another is called a (synergy/synkinesis/triad)

synkinesis

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T/F the pupils have not connection to the rest of the body

F. The pupils reflect the body they live in

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(one/both) pupils dilate to allow in more light

(one/both)pupils constrict to allow better focus

both , both

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If you illuminate one pupil (both/one) pupil will respond

both -it is consensual

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when you are shinning the light to one pupil and checking that same pupil.that is called (direct/consensual)

direct

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T/F both pupils are equal in size

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both pupils will respond equally if a light stimulus is moved will respond (equally/unequally) if a light stimulus is moved from one eye to another

equally

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Anisocoria is when the pupils are (equal/unequal)

unequal-its an anatomic defect

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What is the normal size of  pupils within each other in mm?
A)1.0
B)0.75
C)0.5
D)1.5

0.5

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T/F the level of illumination will not change the amount of anisocoria

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What are the two systems that control pupils?

para and sympathetic system

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In charge of closing (miosis/pupil constriction)
Pupillary light reflex
Target is the iris sphincter
Neurotransmitter is acetylcholine
–is what the (parasympathetic/sympathetic) systems is in charge of

parasympathetic

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About (half/all) the fibers cross over at the __(optic chiasm/brain/cerebellum)__ when light illuminates the retina and signals are carried by the nerve fibers to the brain

half

optic chiasm

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Fibers of the pupil leave the optic tract adn enter teh _(brachium/midbrain) of the superior coliculus

brachium

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pupil fibers head from the (cerebellum/midbrain) toe the pretectal nucleus

midbrain

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The fibers of the pupil leave the optic tract and enter the brachium of the superior coliculus
The pupil fibers head for the midbrain to the pretectal nucleus

describes the pupillary light reflex it s (efferent/afferent) pathway

afferent

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The (midbrain/pretecal/brachium) nucleus sends information to the Edinger-westphal nucleus on both sides
The signal travesl via CN (V / III)

pretecal

III

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The pretectal nucleus sends information to Edinger-Westphal nucleus on both sides
The signal travels via CN III back to eye

describes the pupillary light reflex it s (efferent/afferent) pathway

efferent pathway

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.The pretectal nucleus sends information to Edinger-Westphal nucleus on both sides
.Both pupils constrict!
.Synapse at the ciliary ganglion
.The signal travels via CN III back to eye
.End destination is the iris sphincter

-put these in the correct order

The pretectal nucleus sends information to Edinger-Westphal nucleus on both sides
The signal travels via CN III back to eye
Synapse at the ciliary ganglion
End destination is the iris sphincter
Both pupils constrict!

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After synapse happens at the ciliary ganglion what is the end destination?

iris sphincter

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In charge of opening (mydriasis/dilation)
Normal alert person
Target is the iris dilator
Two neurotransmitters:
Preganglionic is acetylcholine
Post ganglionic is nor-epinephrine
–is what the (parasympathetic/sympathetic) systems is in charge of

sympathetic

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Hypothalamus is in charge of (parasympathetic/sympathetic) impulses

sympathetic

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Sympathetic pathway has a (two/three) neuron are

three

Name the three neuron arc: ___ order neuron ____order neuron ___order neuron

first, second, third

The (hypothalamus/hippus) give vermiform movement and rhythmic movement of pupils

hippus

the (hypthalamus/hippus) is responsible for the unstable equilibrium between teh sphincter and dilator

hippus

T/F hippus is controlled by both the para and sympathetic systems

Near triad includes what?

accommodation, convergence, miosis

The Near triad is (dependent/independent) of illumination Decreased accommodative ability Hyperopes accommodating at distance

independent

older pupils are (larger/smaller)

smaller

Pupils of diabetics are (smaller/larger)

smaller

Pain or ocular inflammation (will/will not) constict the pupil

will

pupils of chronic alcoholics are (large/small)

small

``` Step _: Measure the size of the pupils Bright illumination Dim illumination Step _: Check the afferent system of each eye Step _: Check the direct light reflex Check the consensual reflex Step _: Check the accommodative response (write the correct number order of each step) ```

``` Step 1: Measure the size of the pupils Bright illumination Dim illumination Step 3: Check the afferent system of each eye Step 2: Check the direct light reflex Check the consensual reflex Step 4: Check the accommodative response ```

In step 1 you want to have pt look at a distance of 20/___ letter and have glasses (on/off)

400 off

``` you want to measure your pupil size to the nearest __mm A)1.0 B)0.75 C)0.5 D)1.5 ```

0.5

where do you want to put the light when you do a dim room illumination to measure the pupil in step 1

under the chin

during step 1 , when dim light illuminate pupils (should/shouldn't ) be asymmetric by more than 0.5mm

shouldn't

-Leave illumination dim -Check direct response to illumination of OD: Shine light into right eye _ seconds At distance of 5-6 cm -Check consensual response of OS: Shine light into right eye _ seconds At distance of 5-6 cm A)1,1 B)5,5 C)2,2 D)1.5,1.5

2,2

what does a 4 mean when checking pupillary response

brisk response

When checking (afferent/efferent) integrity of pupil pathway you: - Turn off room illumination - Shine a bright light in OD for at least 3 seconds - Rapidly move the light to the OS - Hold it for at least 3 seconds - The normal pupils should stay equally constricted - Repeat for 2-3 cycles

afferent

When checking the afferent integrity of the pupil normal pupils (should/shouldn't) stay equally constricted

should

T/F Check for the accommodative response only if the direct light response is abnormal/absent!

Unilateral, fixed, dilated pupil | describes which type (anisocoria/amaurotic/hutchinson's) pupil

hutchinson's

-Blind pupil -No direct light reflex describes which type (anisocoria/amaurotic/hutchinson's) pupil

amaurotic

-Pupil size difference of more than 0.5 mm -Look for lid involvement describes which type (anisocoria/amaurotic/hutchinson's) pupil

anisocoria

- Horner’s syndrome - Argyll Robertson pupil - Long standing Adie’s pupil - all have which in common (anisocoria/amaurotic/hutchinson's) pupil

anisocoria

- Defect along the sympathetic pathway - Ptosis: ipsilateral side - Miosis: More noticeable in the dark - Anhydrosis: ipsilateral side, occurs when lesion is before carotid bifurcation and superior cervical ganglion - ---describes which disease (Horner’s syndrome/Argyll Robertson pupil/Long standing Adie’s pupil)

Horner's syndrome

- Posterior hypothalamus to C8-T2 - Most likely lesion is a CVA - Neck trauma - Multiple sclerosis - --is which type of order neuron (first/second/third) in horner's syndrome

first

- Ciliospinal center of Budge (C8-T2) - Leaves spinal cord - Over apex of lung - Synapses at the superior cervical ganglion - Most likely lesion: - Pancoast’s tumor - TB - Metastatic breast cancer - Trauma - Thyroid neoplasm/ surgery - --is which type of order neuron (first/second/third) in horner's syndrome

second

- Post ganglionic - Internal carotid - Two divisions: - Nasociliary to long ciliary nerves innervates the pupil dilator - Internal carotid dissection and aneurysm - Nasopharyngeal carcinoma Along the ophthalmic artery to the eye lid muscle migraines ---is which type of order neuron (first/second/third) in horner's syndrome

third

Horner's syndrome is a defect along the (para/sympathetic pathway)

sympathetic

ptosis in horner's syndrom is (bilateral/ipsilateral)

ipsilateral

(Acquired/congenital) Horner’s syndrome in children under 5 years of age might be due to neuroblastoma in (para/sympathetic) chain of chest and neck

acquired | sympathetic

(Neuroblastoma/cataract) is a malignant (cancerous) tumor that develops from nerve tissue. It usually occurs in infants and children.

neuroblastoma

T/F horner's syndrome in children can come from a brachial plexus injury during birth

T/F horner's syndrome is always malignant and congenital

F it is benign and congenital

(heterochromia/hetrophoria) having a different color iris in each eye

heterochromia

T/F heterochromia is associated with horner's sundrome

-Trauma -Adie’s tonic pupil -Third nerve palsy -Dilating drops -Hutchinson’s pupil all of these are associated with (anisocoria/amaurotic) pupil

anisocoria

T/F in anisocoria only the sphincter is not working well

F it could be either the dilator or the sphincter

in anisocoira the (dilator/sphincter) muscle does not work well when using: - Miotic drops - Iritis - Horner’s syndrome - Argyll Robertson pupil - Long standing Adie’s pupil

dilator

in anisocoira the (dilator/sphincter) muscle does not work well when using: - Trauma - Adie’s tonic pupil - Third nerve palsy - Dilating drops - Hutchinson’s pupil

sphincter

Adie's tonic pupil is a (para/sympathetic) disorder

para sympathetic

- Unilaterally dilated pupil - Poor reaction to light - Slow tonic re-dilation - Denervated ciliary ganglion - 80% unilateral - Becomes bilateral at 4% per year - Sectoral palsy of the iris sphincter - --describes which disease (Horner’s syndrome/Argyll Robertson pupil/Long standing Adie’s pupil)

andies tonic pupil

Light-near dissociation is a (para/sympathetic) disorder

para sympathetic

_______ dissociation Caused by midbrain lesions that are close to the pretectal synapse

light-near

``` in light-near dissociation accommodation fibers out number pupil fiber ___:1 A)30 B)75 C)25 D)15 ```

light-near dissociation is only diagnostically valuable if the direc) light relfex is (absent or abnormal/ present or normal)

absent or abnormal

- Adie’s tonic pupil - Argyll-Robertson pupil - Dorsal midbrain syndrome - Aberrant regeneration of CN III: miosis with -ADDuction - Amyloidosis - Diabetes - -all of these have what type of dissociation in common

light-near dissociation

When checking for accommodative response: - -direct patient to the 20/___ letter at distance - -then switch gase to near card __ cm from their eyes

400, 40

When checking accmmodative response you want to recheck 2-3 looking for both ____ and ___

dilation , constriciton

- Both pupils are constricted and irregular - Near-light dissociation - Dilate poorly in the dark - Respond poorly to dilating agents - Commonly seen in: - Syphilis - Diabetes - Chronic alcoholism - Multiple sclerosis - Sarcoidosis - --describes which disease (Horner’s syndrome/Argyll Robertson pupil/Long standing Adie’s pupil)

argyll roberton pupils

which test checks for the afferent pupillary defect?

swinging fashlight test

The eye with the afferent defect will (dilate/constict) when directly illuminated

dilate

T/F Eye with 20/20 acuity and normal visual fields can have an APD!

If a pupil constricts initially but then dilates you want to trace (RAPD/APD)

APD

If a pupil dilates after a few second then you want to write (1-2+/3-4+)

1-2+

pupil dilates immediately then you write (1-2+/3-4+)

3-4+