Abnormal reactions of pupil

This presentation done by 5th medical student
Any mistakes "if there" is from the sources that were written at the end.

1. Abnormal reactions of pupil Lamyaa Anwar AlGhafli 211523025

2. Objectives 1- Pupil. 2- Normal Pupil Reactions. 3- Anisocoria Vs Isocoria . 4- abnormally shaped pupil. 5- Abnormalities of pupil.

3. pupil Hole located in the center of the iris of the eye that allows light to strike the retina . Control the amount of light entering the eye via contraction ( miosis ) and dilation ( mydriasis ) under the autonomic nervous system . Normal size of pupil ranges from 1-8 mm.

4. Normal Pupil Reactions

5. Normal Pupil Reactions

6. Normal Pupil Reactions

7. Abnormal pupils

8. abnormally shaped pupil Features: Deviation from round pupil. Differential diagnosis: C ongenital defects ( eg , coloboma ), iris inflammation or trauma. A fixed oval pupil, severe pain , red eye, cloudy cornea and systemic malaise acute angle closure glaucoma.

9. Abnormalities of pupil They include ocular disorders and neurologic disorders .

10. 1-Isocoria with Normal Pupil Size A- Relative Afferent Pupillary Defect Causes: Unilateral sensory disorder such as retinal detachment, neuritis of the optic nerve, atrophy of the optic nerve, or retinal vascular occlusion . B- Bilateral Afferent Pupillary Defect Causes: Bilateral sensory disorder such as maculopathy or atrophy of the optic nerve .

11. 2- Anisocoria with Dilated Pupil in the Affected Eye A- Complete Oculomotor Palsy Causes: 1- Processes in the base of the skull such as tumors, aneurysms, inflammation or bleeding. 2- Processes in the area of the superior orbital fissure or apex of the orbit. Diagnostic considerations: 1- L ight reflexes: No constriction in the affected eye. 2- Near reflex: absent. 3- Impaired motility and double vision .

12. 2- Anisocoria with Dilated Pupil in the Affected Eye B- Tonic Pupil Causes: Postganglionic damage to the parasympathetic pathway, that occurs with DM, alcoholism, viral infection and trauma . Diagnostic considerations:

13. 2- Anisocoria with Dilated Pupil in the Affected Eye C- Iris Defects Causes: Trauma , Secondary to acute angle closure glaucoma, Synechiae (post- iritis or postoperative) D- Following Eyedrop Application By asymmetrical supranuclear inhibition of the Edinger – Westphal nucleus.

14. 3- Anisocoria with a Constricted Pupil in the Affected Eye A- Horner Syndrome Causes : Damage to the sympathetic pathway. 1- Central (first neuron): Tumors, Encephalitis 2- Peripheral (second neuron): Same the central, Trauma , Rhinopharyngeal tumors, Goiter, Aneurysm. 3- Peripheral in the strict sense (third neuron): Vascular processes, Internal carotid aneurysm.

15. 3- Anisocoria with a Constricted Pupil in the Affected Eye Clinical picture: SAMPLE

16. 3- Anisocoria with a Constricted Pupil in the Affected Eye Peripheral Horner syndrome. On the affected side, there is slight mydriasis On the unaffected side , there is significant mydriasis . Central Horner syndrome. On both, the pupils are dilated . B- Following Eyedrop Application Unilateral Administration of a Miotic as in Glaucoma Therapy.

17. 4 - Isocoria with Constricted Pupils A- Argyll Robertson Pupil: Causes: The precise location of the lesion is not known. Diagnostic considerations: 1- The pupil is not roundand and constriction is not always symmetrical. 2 - There is no reaction to darkness or pharmacologic stimuli.

18. 4 - Isocoria with Constricted Pupils B- Bilateral Pupillary Constriction due to Pharmacologic Agents Causes: Morphine, Deep general anesthesia. C- Toxic Bilateral Pupillary Constriction Causes: mushroom poisoning. D- Inflammatory Bilateral Pupillary Constriction Causes: Encephalitis, Meningitis

19. 5 - Isocoria with Dilated Pupils A- Parinaud Oculoglandular Syndrome Causes: Tumors such as pineal gland tumors. Diagnostic considerations: 1- Fixed dilated pupils. 2- Normal near reflex. 3- Limited upward gaze and retraction nystagmus.

20. 5 - Isocoria with Dilated Pupils B- Intoxication Causes: Atropine , spasmolytic agents, anti-Parkinson agents, antidepressants, botulism, carbon monoxide and cocaine. C- Disorders Causes: Migraine, Schizophrenia , Hyperthyredosis , Hysteria , Epileptic seizure and Coma.

21. http://www.imedicalapps.com / iRis interactive

22. summary 1- Isocoria : the problem in afferent pathway Anisocoria : the problem in efferent pathway 2- Direct light response, Swinging flashlight test and accommodation test are important tests to assess the pupil. 3- Disorders cause isocoria : Argyll Robertson Pupil and Parinaud Oculoglandular Syndrome. Disorders cause anisocoria : Complete Oculomotor Palsy, Tonic Pupil and Horner Syndrome.

23. Resources 1- Ophthalmology A Pocket Textbook Atlas, Gerhard K. Lang, MD, Oskar Gareis, Gabriele E. Lang, Doris Recker, Peter Wagner, Second edition 2- Lecture Notes On Ophthalmology, BRUCE JAMES, CHRIS CHEW, ANTHONY BRON, Ninth Edition 3 - http:// www.patient.co.uk/doctor/pupillary-abnormalities