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Flashcards in Pupils - Lynch Deck (15)
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1

Afferent Pupil

Releative Afferent Pupil Defect (RAPD) if defect in the "in" information

CN 2 (Optic Nerve)

2

Efferent Pupil

Anisocoria (unequal pupils) if defect is in the "out" signal

CN 3

Parasympathetic constricts

Sympathetic dilates

3

Near Triad

Miosis

Convergence

Accomodation

4

Pupillary Responses

Direct

Consensual

Accomodative

5

Relative Afferent Pupillary Defect (RAPD)

Marcus-Gun Pupil

objective measure of the afferent light input of one eye compared to the other

signifies asymmetric pre-geniculate damage - examples: retinal lesions, ispsilateral optic nerve, optic tract

tested by Swinging Flashlight Test

no anioscoria, not due to cataracts or corneal opacity

6

In an abnormally large pupil anisocoria is greatest in ____________?

In an abnormally small pupil - anisocoria is greatest in ____________?

abnormally large pupil - anisocoria greatest in light

 

abnormally small pupil - anisocoria greatest in dark

7

Identify this condition and describe the treatment and management: 

abnormally large pupil, vermiform movement of iris, sgemental/sector sphincter palsy

Adie's Pupil

etiology: infection, inflammation, ischemia, local anesthesia, surgery, laser, trauma, autonomic

tonic pupil causes: diabetes, chronic alcoholism, encephalitis

treatment: increase biofocal strength, pilocarpine

8

Identify this condition and describe the treatment and management: 

absent deep tendon reflexes, hyperthermia, syncopal episodes, dysgeusia, chronic GI motlity, tonic pupils

Adie's Syndrome

refer for a neurology consult

9

Pharmacologic Mydriasis

large dilated pupil

does not react to light or near

does not react well to miotics

exposure to :

  • dilating drops
  • parsympatholytic agents (Atropine, Asthma medicine)
  • plants (Belladonna, Jimson Weed)
  • pesticides

 

 

10

Cranial Nerve III Palsy

Associated with ptosis +/- EOM abnormality

Pupil involving a third nerve palsy - is an anerusym until proven otherwise

Causes: PCA aneurysm, trauma, brain tumor, microvascular ischemia

Isolated dilated pupil - not likely to be thrid nerve palsy

 

11

Pharmacologic Miosis

small pupil - poor reaction to light and near stimuli

exposure to:

  • acetycholinesterases
  • tick and flea collars
  • pilocarpine and topical parasympathomimetics

12

Aberrent Reinnervation

third nerve palsy with smaller pupil

does NOT react well to light

light-near disocciation

clincial features: unilateral miosis which accompanies eye movement may also have lid elevation/retraction with eye movement

13

Horner's Syndrome Symptoms

Ptosis

Miosis

Anhydrosis

14

Etiology of Horner's Syndrome

Congenital - affected eye may be lighter, likely from birth trauma

Acquired - cartoid dissection, carotid aneurysm, apical lung tumor (Pancoast tumor), occult neuroblastoma

15

Pharmacologic Diagnosis of Horner's Syndrome

Cocaine Testing - confirms - nothing enstilled in eye before, Horner's pupil dilates less than normal one

Apraclonidine - little or no effect on a normal pupil

Localization of Horner's Syndrome - Hydroxyamphetamine Testing: done 48 hours after cocaine test