Pupil anomalies and disorders shiva ppt
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Transcript of Pupil anomalies and disorders shiva ppt
Pupil abnormolities & anomalies
By;-M. Shivaram11immo14
Optometry&vision sciences
Pupil;- an aperture located in the centre of the iris that allows light to enter the retina.
round in shape and relatively equal in size
size vary from 2 to 8mm in diameterNormal pupils range from 3 to 5mm in ambient light
conditions
Miotic pupils are less than 3mm
Mydriatic pupils are greater than 7mm
Pupil disordersMicrocoria
Megalocoria
Anisocoria
Polycoria
Correctopia
Microcoria (small pupil)
Differential diagnosis –pilocarpine drops, uvietis with synaechiae, Horner's syndrome.
Megalocoria: (large pupil)
Differential diagnosistraumatic iris damage, third cranial nerve palsypharmacological dilation (i.e. dilating drops), Adie's pupil iris rubeosis
More than one pupil is called as polycoria
Polycoria (multiple pupils)
Corectopia
eccentric displacement of pupil called corectopia
Pupil anomalies 1-Argyll Robertson pupil
2-Reverse argryll robertson pupil
3-Adie’s tonic pupil
4-Horner’s syndrome
5-(Marcus gunn pupil) RAPD
6-Amaurotic pupil
7-Hutchinson’s pupil
8-Paradoxical pupil 9-Hippus
1-Argyll Robertson pupil
Hallmark of neurosyphilis ,No reaction to
light but brisk response to near ,Pupil is
small & irregular in shape
Diff-diagnosis;- encephalitis,parinauds syndrome
2-Reverse argryll robertson pupil
In this accommodation and reflex on the pupil is absent
causes;- Diptheria&
tumors at carpora quadrigemina
3-Adie’s tonic pupil
occurs mainly due lesion in the ciliary ganglions.
This lesion is thought to be caused by denervation of the post
ganglionic nerve supply to the sphincter and ciliary muscle
affected eye is dilated and reacts poorly to light (poor direct and consensual response)
Diff-diagnosis;-herpes zoster
opthalmicus,
adies syndrome
4-Horner’s syndrome
Horner's syndrome is due to damage or blockage of
the path of the sympathetic nerve which travels
through the neck and brain from the affected eye.
total or partial interruption of the sympathetic
pathway.
It consist of anisocoria miosis, ptosis &
enophthalmus and decrease in the facial sweating on
the affected side.
5-(Marcus gunn pupil) RAPD
It is due to the conduction defect of the optic nerve- particularly the
afferent fibers are defective
.In this, both the pupils will dilate a little when the abnormal eye is
stimulated.
The affected eye constricts less & redilates more than a normal eye. The
effected eye has a greater consensual response coming from the normal
eye than direct.
DIFF diag;- opticnerve tumors, retirobulbar neuritis
RAPD-- +
6-Amaurotic pupil (leucocoria)
A pupil in an eye that is blind because of ocular or
optic nerve disease and that contracts in response
to light only when the normal eye is stimulated with
light white pupillary reflex indicates abnormmal
red reflex indicates normal.
Causes: congenital cataract, retinoblastoma, ROP, toxocaris
7-Hutchinson’s pupil
due to the compression of the 3rd
nerve which is due to the meningeal
hemorrhage at the base of the brain.
It may also be due to central nervous
system lesion that compresses the
optic nerve. Dilation of one pupil when
the other pupil is constricted
(unilateral pupil dilation)
8-Paradoxical pupil
Parodoxicall pupil has a intresting reaction whereNormally pupil should constrict when light shown but in this condition
Lights on - pupil dilatesLights off -pupil constricts There is no particular causes for this but due to retinal & neuronal disorders it may happens Research studies are going on this pupillary reflex
Video to watch pupillary response
https://www.youtube.com/watch?v=yMvJfmJaTjM
9-Hippus
Irregular rythamatic visible pupillary oscillations 2mm / more in amplitude
irregular dilating & constricting movements are observed
Also called as pupillary athestosis
causes;- myasthenia gravis
References;-clinical ophthalmology by Jack j Kansky
6th –edition
Pediatric ophthalmologyby kenneth & wright-3rd edtn
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