Mohammad Pakravan MD Associate Professor Labbafinejad Medical Center.
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Transcript of Mohammad Pakravan MD Associate Professor Labbafinejad Medical Center.
Pupils
Are a round and equal holes in the middle of iris which adjust light entrance into the eye.
Sphincter by 3th N, dilators by sympathetic3 to 6 mm in normal light.They are larger in children than eldery.Miosis is pupil diameter less than 3 mm.
- cholinergics - morphine- sleeping
Mydriasis when pupil diameter more than 6mm
Dyscoria Abnormalities of pupil shapeCorectopia PolycoriaIridoplegia in response to light and near
effortIris bombe
Anisocoria physiologic less than 0.5mm
- more prevalent in elderlySphincter rupturePS in uveitisAACG3th n palsy
- compressive- microvascular
Horner syndrome
Horner’s syndromeMiosis, ptosis, anhydrosisAny problem in sympathetic pathway
- boroncogenic carsinoma of lung apex (pancost’s tumor)- neck trauma- syrengomyelia - aorta or carotid artery aneurysm- neck spinal tumor- idiopathic congenital (heterochromia iridis)- brain stem vascular abnormality
Pharmacologic tests for anisocoriaCocaine 4- 10% prevent reuptake of
neurepinephrine and induce mydriasis in normal eye but not in Horner’s syndrome.
Hydroxyamphetamine 1% releases neuradrenaline in synapsis and is effective in preganglionic type but not effective in postsynaptic type.
Sympathetic pathwayBrain stem > medulla > C8, T1 , T2 > apex of
lung > aorta > superior cervical sympathetic chain > internal carotid > muller muscles and dilator muscle of pupil
Parasympathetic pathwayPupillomotor nerves > brain stem
sublentiform nucleus > edinger westphal nucleuses> 3th N nasocilliary > ciliary ganglion > sphincter muscles of iris
RAPD (relative afferent pupillary defect); Marcus Gunn PupilIn retinal or optic nerve diseaseNot seen in cataractIs graded from 0 to 4+
Argyll-Robertson pupil; Tabes dorsalisSmall, irregular, unequal pupilsUsually bilateralResponse to light is small or negative.Remained response to accommodationUsually bilateralPupils dilate poorly
Tonic pupil; Holmes AdieInnervations of Pupillary sphincter and or
ciliary muscles are involved80% unilateralBenign and more prevalent in femalesInvolved pupil is dilated and irregularPoor response to lightRemained response to nearMaybe accompanied by deep tendon reflex
involvement (Adie’s syndrome)Slow accomodation