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Flashcards in Neurophthalmology Deck (22)
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1
Q
anisocoria
A
a difference in size between pupils
2
Q
Neurophthalmology exam
A
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
3
Q
light-near dissociation
A
better constriction when viewing a near object than to light stimulation
4
Q
segmental palsy
A
unequal constriction of the pupil
5
Q
Sympathetic pupillary disturbances:
A
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.
6
Q
ParaSympathetic pupillary disturbances:
A
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.
7
Q
Horner’s Syndrome: symp or para
A
sympathetic problem
8
Q
Horner’s Syndrome: anisocoria
A
miosis
9
Q
Horner’s Syndrome: light reaction
A
abnormal dark reaction
10
Q
Horner’s Syndrome: other signs
A
Also accompanied by Ptosis and anhidrosis (usually unilaterally)
11
Q
Iris Damage: symp or para
A
Parasympathetic Problem
12
Q
iris damage: anisocoria
A
myadriasis
13
Q
iris damage: light reaction
A
abnormal light reaction
14
Q
iris damage: other signs
A
non-neurologic cause
15
Q
3rd Nerve Palsy: symp or para
A
parasympathetic problems
16
Q
3rd Nerve Palsy: anisocoria
A
mydriasis
17
Q
3rd Nerve Palsy: light reaction
A
abnormal light reaction
18
Q
3rd Nerve Palsy: other signs
A
Accompanied by other signs of 3rd nerve damage including ptosis and EOM paresis
19
Q
Tonic Pupil: symp or para
A
parasympathetic problem
20
Q
Tonic Pupil: anisocoria
A
myadriasis
21
Q
Tonic Pupil: light reaction
A
abnormal light reaction
22
Q
Tonic Pupil: other signs
A
1. Light-near dissociation
(due to regrowth of nerve fibers, more of which are dedicated to accommodation) and
2. segmental constriction