Abnormal pupil reactions - mehedi hasan

A ppt on Abnormal pupillary reactions. Most of the slides are collected from the internet. talked about pupillary pathway and reflexes.

1. ABNORMAL PUPILLARY REACTIONS MEHEDI HASAN JUNIOR OPTOMETRIST The largest & oldest multispecialty eye hospital

2. Pupil It is a circular aperture at the center of the iris that allows light to enter the retina. The normal pupil size in adults varies from 2 to 4 mm in diameter in bright light to 4 to 8 mm in the dark.

3. Functions of pupil Regulates amount of light entering eye ( Dilation and Constriction) Reduces spherical , chromatic aberration Increases depth of focus Sphincter pupillae (Constrictor)   Dilator pupillae

4. Evaluation Are the pupils round or irregularly shaped ? Are the pupils equal in size ? In light and dark ? Do the pupils react to a light stimulus ? If not , do they react to a near target ?

5. HOw do we record Parameters Right eye Left eye Size of pupil in dark Size of pupil in light Reaction to light (direct) Reaction to light (indirect) Reaction to Near Dilation to dark

6. size 1. Hand-held pupil gauge (Haab scale) 2.Hand-held pupil camera 3.Infra red video Pupilography

7. The Light reflex

8. The Light reflex Optic nerve

9. The Light reflex Optic nerve Optic chiasma

10. The Light reflex Optic nerve Optic chiasma Optical tract

11. The Light reflex Optic nerve Optic chiasma Optical tract The pretectal nucleus

12. The Light reflex Optic nerve Optic chiasma Optical tract The pretectal nucleus Edinger-Westphal nucleus

13. The Light reflex Optic nerve Optic chiasma Optical tract The pretectal nucleus Edinger-Westphal nucleus Oculomotor nerve ( CN III )

14. The Light reflex Optic nerve Optic chiasma Optical tract The pretectal nucleus Edinger-Westphal nucleus Oculomotor nerve ( CN III ) Ciliary ganglion

15. The Light reflex Optic nerve Optic chiasma Optical tract The pretectal nucleus Edinger-Westphal nucleus Oculomotor nerve ( CN III ) Ciliary ganglion Short ciliary nerves to both constrictors of the eye (Sphincter pupillae muscle)

16. The Light reflex If light enters an eye, the pupil of this eye constricts (direct light reflex), and there is an equal constriction of the pupil of the other eye (consensual light reflex).

17. Near reflex ( Accommodation reflex / accommodation-convergence reflex ) Near Reflex is basically a triad of : I. Miosis II. Convergence III. Accommodation Afferent impulses remain the same as the light reflex. The near reflex pathway bypasses the pretectal nuclei and descends directly to EWN. From the ciliary ganglion to both : ciliary ganglion for accommodation & ciliary muscle for sphincter pupillae.

18. near reflex Important if direct response is weak. Moderate room light . Use Accommodative target.

19. L IGHT-NEAR DISSOCIATION NEAR RESPONSE > LIGHT RESPONSE = LIGHT-NEAR DISSOCIATION

20. PUPILLARY DILATION Looking for dilation lag. Normal pupillary dilation involves : Sphincter relaxation + Dilator contraction Normal pupils return to their widest size within 12 - 15 seconds ( max occurs within 5 seconds ) Dilation lag is present when pupil takes 25 seconds to return to maximum size in dark ( starting after 10 - 12 seconds )

21. abnormalities

22. afferent pupillary defect

23. Relative Afferent Pupillary Defect (RAPD, Marcus Gunn Pupil)

24. Relative Afferent Pupillary Defect (RAPD, Marcus Gunn Pupil)

25. grading of rapd

26. paradoxical pupillary phenomena The pupil starts constricting in dark at first ,then starts dilating. Causes : CSNB Congenital achromatopsia Optic nerve hypoplasia leber's congenital amaurosis Albinism RP

27. Anisocoria Anisocoria is a condition characterized by an unequal size of the pupils.

28. Anisocoria Anisocoria is a condition characterized by an unequal size of the pupils. Physiological ( Anisocoria of around 1 mm is present in around 20% of the normal population)

29. Anisocoria Anisocoria is a condition characterized by an unequal size of the pupils. Physiological ( Anisocoria of around 1 mm is present in around 20% of the normal population) Pathological

30. Anisocoria Anisocoria is a condition characterized by an unequal size of the pupils. Physiological ( Anisocoria of around 1 mm is present in around 20% of the normal population) Pathological Size Reactions Pharmacological tests

31. Adie's (Tonic) Pupil The tonic pupil, sometimes called Adie tonic pupil or simply the Adie pupil, is the term used to denote a pupil with parasympathetic denervation that constricts poorly to light but reacts better to accommodation (near response), such that the initially larger Adie pupil becomes smaller than its normal fellow and remains tonically constricted, redilating very slowly when exposed to dark. Caused by the damage to the postganglionic parasympathetic fibres i.e, at level of ciliary ganglion or short ciliary nerves

32. Right Adie pupil. (A) Large right pupil; (B) absent or sluggish direct light reflex; (C) consensual light reflex is similar A B C

33. Argyll Robertson Pupil Small ( >2mm ), irregular pupils (almost always bilateral) No reaction to light,normal near response (light near dissociation), often iris atrophy and iris transillumination defects, and poor dilation with drops

34. The entire syndrome includes : „ Absence of light reaction, „ Presence of accommodation reaction, „ Pupils are miotic, irregular „ Atrophic depigmented patches on iris. „ Pupils fail to dilate with mydriatic, but constrict further with eserine. „ Presence of good vision in both eyes.

35. Horner's Syndrome Light illumination Dark illumination

36. Horner's Syndrome A B Horner syndrome. (A) Right Horner syndrome; (B) heterochromia iridis associated with a left congenital Horner syndrome in a child

37. Hutchinson's pupil A pupil that is dilated and completely inactive to all stimuli. It is associated with lesions of the central nervous system, as may occur in head injury. Stage 1 : the parasympathetic fibers on the side of injury are irritated, leading to constriction of pupil on that side. stage 2 : the parasympathetic fibers on the side of injury are paralysed, leading to dilatation of pupil. The fibers on the opposite oculomotor nerve are irritated, leading to constriction on opposite side. stage 3 : the parasympathetic fibers on both sides are paralysed - leading to bilateral pupillary dilatation.

38. Third nerve palsy Pupillary dysfunction associated with ptosis and limitation of extraocular mobility pupil mid-dilated Maximum anisocoria occurs in bright light 0.125% pilocarpine no constriction but constrict with 1%

39. Wernicke’s Hemianopic pupil Wernicke's Hemianopic pupil occurs as a result of a lesion in the optic tract . Light reflex is absent on temporal half of the retina of affected side and nasal half on the opposite side. Light reflex is present on nasal half of affected side and temporal half of opposite side.

40. Tadpole pupil Tadpole pupil is a rare phenomenon in which segmental spasm of the iris dilator muscle results in a tadpole-shaped pupil

41. Tadpole pupil

42. keyhole pupil A pupil with an coloboma at the pupillary margin.

43. home message

44. EVERY ENDING IS REALLY JUST A NEW BEGINING

45. A N Y Q U E S T I O N S ? A N W E R