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Flashcards in Neurophthalmology Deck (22):
1

anisocoria

a difference in size between pupils

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Neurophthalmology exam

1. look for anisocoria
2. check normal reaction to light and dark
3. observe pupils in light and dark
4. observe papillary response to light
5. observe for segmental palsy
6. observe for light-near dissociation
7. observe for tonic dilation

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light-near dissociation

better constriction when viewing a near object than to light stimulation

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segmental palsy

unequal constriction of the pupil

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Sympathetic pupillary disturbances:

1. Sympathetic innervation normally results in papillary dilation.
2. If sympathetic pathways are damaged the abnormal pupil will be miotic and will have an abnormal dark reaction, meaning it will not fully dilate.
3. This makes the anisocoria worse in the dark.

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ParaSympathetic pupillary disturbances:

1. Parasympathetic innervation causes papillary constriction, so damage will result in a pupil that is mydriatic and poorly responsive to light.
2. The anisocoria thus appears worse in the light.

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Horner’s Syndrome: symp or para

sympathetic problem

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Horner’s Syndrome: anisocoria

miosis

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Horner’s Syndrome: light reaction

abnormal dark reaction

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Horner’s Syndrome: other signs

Also accompanied by Ptosis and anhidrosis (usually unilaterally)

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Iris Damage: symp or para

Parasympathetic Problem

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iris damage: anisocoria

myadriasis

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iris damage: light reaction

abnormal light reaction

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iris damage: other signs

non-neurologic cause

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3rd Nerve Palsy: symp or para

parasympathetic problems

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3rd Nerve Palsy: anisocoria

mydriasis

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3rd Nerve Palsy: light reaction

abnormal light reaction

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3rd Nerve Palsy: other signs

Accompanied by other signs of 3rd nerve damage including ptosis and EOM paresis

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Tonic Pupil: symp or para

parasympathetic problem

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Tonic Pupil: anisocoria

myadriasis

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Tonic Pupil: light reaction

abnormal light reaction

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Tonic Pupil: other signs

1. Light-near dissociation
(due to regrowth of nerve fibers, more of which are dedicated to accommodation) and
2. segmental constriction