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Pupil abnormalities

Author: nuke, Posted on Wednesday, November 05 @ 11:45:03 IST by RxPG  

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Ophthalmology

Bilateral

Miosis pupillary constriction Iridocyclitis, miotic eye drops (pilocarpine)

Mydriasis pupillary dilation Iridocyclitis, mydriatic or cycloplegic drops (atropine); midbrain (reflex arc) lesions or hypoxia; oculomotor CNIII damage; acute angle glaucoma

Failure to respond (constrict) with light stimulus Iridocyclitis; corneal or lens opacity; retinal degeneration; optic nerve CNII destruction; midbrain synapses involving afferent pupillary fibers or oculomotor nerve; impairment of efferent fibers that innervate sphincter pupillae muscle

Argyll Robertson pupil Bilateral, miotic, irregularly shaped pupils that fail to constrict with light but retain constriction with convergence; pupils may or may not be equal in size; commonly caused by neurosyphilis or lesions in midbrain


Unilateral

Anisocoria unequal pupils Congenital or caused by local eye medications, amblyopia or unilateral sympathetic or parasympathetic papillary pathway destruction

Iris constrictive response Acute uveitis is frequently unilateral; constriction of pupil accompanied by pain and cicumcorneal flush

Oculomotor nerve damage Pupil dilated and fixed; eye deviated laterally and downward; ptosis

Adie pupil (tonic pupil) Affected pupil dilated and reacts slowly or fails to react to light; responds to convergence; caused by impairment of postganglionic parasympathetic innervation to sphincter pupillae muscle or ciliary malfunction; often accompanied by diminished tendon reflexes (diabetes or alcoholism)



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