pupil new in ocular content like rapd

8/19/2019 pupil new in ocular content like rapd

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Pupil examinationMantu Akon


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Modifes amount o light entering eye;increases sensitivity o eye

Increases depth o ocus

Minimizes chromatic and sphericalaberrations.

Pupil function


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Retinal stimulation produces a pupilresponse however a larger response isproduced with oveal stimulation.

Accommodation and convergence canchange pupillary size hysiological and emotional states can

change pupillary size.

!arious drugs can a"ect the pupils

condition where pupil sizechange


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#he frst $uestion is whether there is anyanisocoria (pupils unequal in size).

I anisocoria is present% there is either a

deect in the e"erent part o the light re&e'(e"erent pupillary deect) or physiologicalanisocoria. *esions o the a"erent arm othe pathway do not produce anisocoria.

Pupil examination


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Also look or heterochromia, or di"eringcolour o the iris in each eye+ one iris maybe hypochromic% or lighter than normal% incongenital or long,standing -ornersyndrome. heck whether the pupils areregular.

An irregular pupiln margin may indicate

trauma or previous surgery.

Pupil examination


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/o not miss ptosis (drooping) o the eyelidwhich may be partial (-orner syndrome) orcomplete (third nerve palsy).


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-orner syndrome Argyll Robertson pupil *ong,standing Adie pupil

Iritis Miotic drugs eg pilocarpine

Smaller pupil abnormal


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ompressive third nerve palsy Adie pupil Iris sphincter damage

Mydriatic drugs eg atropine

Larger pupil abnormal


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#he direct response will be absent orreduced (sluggish) i there is damage at anypoint along the a"erent arm (retinalpathology% or a lesion o the optic nerve%optic chiasm or optic tract.

0r e"erent arm (ArgyllRobertson pupil%compressive third nerve palsy% Adie pupil) o

the pupillary light re&e' or that eye.

direct and consensualpupillary light responses


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A relatie a!erent pupillary defect(RA/% Marcus 1unn pupil) is a parado'icaldilatation o the pupil when a &ashlight isswung rom the contralateral eye to thea"ected eye.


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#his is caused by a lesion anywhere alongthe course o the sympathetic nerve supplyto the dilator pupillae muscle.

#hus% -orner syndrome is also knownappropriately% as oculosympathetic palsy. 2ecause pupillary dilatation by the dilator

pupillae is impaired the -orner pupil is

miosed and the anisocoria is greater in dimlight.

"orner#s syndrome


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0ther eatures o the syndrome may includea partial ptosis(which can alsely give theimpression o enophthalmos)% reducedipsilateral acial sweating and% in long,standing disease%hypochromicheterochromia.

#wo important causes o -orner syndrome

are lung cancer% which can compress thenerve in the neck% and a carotid arterydissection.


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#his is caused by damage to theinternuncial neurons induced in the latestage o syphilis% an uncommon se'ually,transmitted disease.

2oth eyes are usually involved% thoughasymmetrically.

#he pupils are irregular and small% and light,

near dissociation is present.

$rgyll %obertson pupil


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atients with iritis% or in&ammation o theiris% have a painul red eye. #he pupil maybe small owing to iris spasm.

In&ammation may cause adhesionsbetween the iris and lens (posteriorsynechiae) so that the pupil appearsunreactive.

3ntreated iritis may lead to angle closureglaucoma% cataract and macular oedema.

&ritis


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A lesion that compresses the third cranialnerve (an alternative name or theoculomotor nerve) may also compress theparasympathetic preganglionic motorpupillary nerve fbres% which run on itssurace. alsy% or paralysis% o the thirdnerve due to compression results incomplete ptosis and weakness o allductions e'cept abduction.

'ompressie third nerepalsy


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#his is due to disruption o the parasympatheticpostganglionic motor nerve supply to the sphincterpupillae.

It is typically unilateral and usually occurs in young

adults ater a viral inection. 4ormal constriction o the pupil is impaired% causing

it to become dilated. #he anisocoria is greater in bright light% and the

pupil responds sluggishly% or not at all% to light. 5lit,lamp e'amination o the pupillary border reveals

vermiorm (worm,like) movements in response tolight.

$die#s pupil


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#raumatic damage to the iris sphinctermuscle% which encircles the pupillarymargin% will impair its unction% causingailure o pupillary constriction.

#he pupil may appear f'ed and dilated. #hediagnosis should be clear rom the history%evidence o iris damage on slit,lamp

e'amination% and ailure o the pupil toconstrict with topical pilocarpine 67.

&ris sphincter damage


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pupil new in ocular content like rapd

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