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Flashcards in Pupils Deck (25):
1

What is abnormal anisocoria?

pupil size difference of more than 0.5 mm (look for lid involvement)

2

What is an amaurotic pupil?

Blind pupil; no DIRECT light reflex

3

What is Hutchinson's pupil?

unilateral, fixed, dilated pupil

4

When does anhydrosis occur in Horner's Syndrome?

when lesion is before carotid bifurcation and superior cervical ganglion

5

What is Horner's syndrome and list three symptoms/effects?

a defect along the sympathetic pathway; ptosis, miosis, and anhydrosis

6

Where do the first order neurons of the sympathetic pathway extend (to and fro)?

posterior hypothalamus to C8-T2

7

What are 3 possible causes for first order neuron Horner's Syndrome?

cerebrovascular accident (stroke), neck trauma, multiple sclerosis

8

What are 5 possible causes for second order neuron Horner's Syndrome?

Pancoast's tumor, Tuberculosis, Metastatic breast cancer, trauma, thyroid neoplasm/surgery

9

Where do the Second order neurons extend from and to

leave spinal cord, over apex of lungs, synapse in superior cervical ganglion

10

Third order neurons are post-ganglionic and travel on the internal carotid until the break into what two separate divisions/pathways

nasociliary nerve -> long ciliary nerves -> pupil dilator,
opthalmic artery -> eyelid muscles (levator palpebrae superioris)

11

What can affect the nasociliary pathway of the 3rd order neurons

internal carotid dissection and aneurysm, and a nasopharyngeal carcinoma

12

What can affect the opthalmic artery pathway of the 3rd order neurons

Migraines

13

Is Horner's Syndrome in children benign or malignant when it is congenital

benign (brachial plexus injury during birth) but need to rule out a neuroblastoma in sympathetic chain of chest/neck (acquired Horner's may also be due to a neuroblastoma)

14

When is light-near dissociation diagnostically valuable

if the direct light reflex is absent or abnormal

15

What is the light-near dissociation phenomenon

when response to accommodation is stronger than light response (accommodation fibers out number pupil fibers 30:1)

16

In patients with anisocoria when is a dilated pupil more noticeable and when is a miotic pupil more noticeable

dilated in illumination (sphincter muscle not working well)
miotic in the dark (dilator muscle not working well)

17

List 4 disorders of the para-sympathetic system

trauma, adie's tonic pupil, third nerve palsy, hutchinson's pupil

18

What is Adie's Tonic Pupil

unilaterally dilated pupil with poor reaction to light and slow tonic re-dilation

19

What is Adie's tonic pupil due to

a denervated ciliary ganglion (sectoral palsy of the iris sphincter)

20

At what rate does the Adie's tonic pupil become bilateral

(most cases - 80% unilateral), becomes bilateral at 4% per year

21

What symptoms/issues are present with Argyll-Robertson pupils

both pupils are constricted, dilate poorly, respond poorly to dilating agents

22

When is Argyll-Robertson's commonly seen

in patients with syphilis, diabetes, chronic alcoholism, multiple sclerosis, and sarcoidosis

23

When do you check for accommodative response

only if direct light response is abnormal or absent

24

When is an afferent pathway defect detected (APD)

during "swinging flashlight test"

25

Can an eye with normal visual fields and 20/20 acuity have an APD

YES