- parasympathetic innervates the pupillary constrictors via CN III and these kinds of receptors

M3 (Acetylcholine)

- sympathetic innervates the pupillary dilators via sympathetic nerves and these kinds of receptors

alpha-1

- refers to pupillary dilation

Mydriasis

- refers to pupillary constriction

Miosis

- size of the normal pupil during an exam that the pt looks at a distant object reveals this pupil effect aging

Decrease in size

(7mm at 10 yr, 4 mm at 80 yr)

- the name of the motion that describes the continuous small pupillary dilation and constriction

Hippus

- when the non-illuminated pupil constricts to input on the contralateral eye

Consensual reflex

- a slight variation of the pupils in relation to each other is termed this (<1 mm)

Simple anisocoria

- this test reveals asymettric retinal or optic nerve disease because of the difference in the amount of pupillary constriction to an alternating eye flashlight

Swinging flashlight test

- a discrepant reaction to light (via the swinging flashlight test) is called this

afferant pupillary defect

(Marcus Gunn pupil)

- this eye problem does not usually cause an afferent pupillary defect because the retina compensates as it does in dim light

Cataracts

- "Popos" look for this eye finding when testing for drugs or alcohol on the roadside

Lack of constriction

- impaired parasympathetic motor innervation to the pupillary sphincter causes the affected eye to fail to react to ipsilateral and contralateral stimulation and is called this

- during ipsilateral stimulation, the opposite does constrict

Efferent pupillary defect

- small, occur bilaterally, and fail to dilate fully in dim light

- accommodates to near vision but fails to react to light

- condition associated with tertiary syphilis, MS, sarcoidosis, diabetes mellitus, Lyme disease and following trauma

- lesion from the dorsal midbrain

Argyll-Robertson pupil

- if an Argyll-Robertson pupil occurs with vision impairment, this should be expected

Severe retinal and optic nerve disease

- fails to immediately constrict in response to light OR accommodation

- after prolonged attempt, accommodates and re-dilates slowly

- frequently unilaterally OVAL in appearance

- pt's notice inability to focus on near objects

- may result from 3rd nerve brain herniation, surgery, injury to ciliary ganglion or idiopathically

Adie's (tonic) pupil

- Adie's pupil in conjunction with a decreased Achilles reflex

Holmes-Adie syndrome

- this disease can cause pupillary defects including small pupils that fail to dilate normally in darkness and ones that have sluggish constriction to bright light

- these problems are due to sympathetic and parasympathetic denervation respectively

Diabetes

- this eye response requires connection to the occipital cortex and these three "C" components

1- ocular convergence

2- pupillary constriction

3- thickening of the lens from ciliary muscle contraction

- weakness of ocular convergence during near accommodation

- develops with Graves' hyperthyroidism due to myopathy of the medial recti

Mobius' sign

- anisocoria is no longer simple when there is an inequality of >0.5 mm in bright light or >1 mm in dim light

- it should be described as this

Abnormal anisocoria

- the difference in size between the pupils is constant and doesn't change with different levels of illumination

Physiologic anisocoria

- asymmetric iridic disease (mechanical damage)

- 3rd nerve or sympathetic palsy (pharmacological)

Causes of anisocoria

- this is not a cause of anisocoria because it shouldn't have an effect on pupillary reaction

unilateral decrease in vision

via

optic nerve or retina problems/cataracts/corneal opacity

-

Anisocoria that increases in dim illumination vs bright indicates sympathetic paresis or parasympathetic palsy (3rd nerve lesion)?

Sympathetic (greater dilation)

Anisocoria that increases in bright illumination vs dim indicates sympathetic paresis or parasympathetic palsy (3rd nerve lesion)?

Parasympathetic palsy (greater constriction)

- these people experience "sundowning" which is intermittent downward deviation of both eyes

Babies for 1st few weeks (Preemies)

- if sundowning is associated with poor feeding, vomiting, lethargy, or a bulging anterior fontanelle this should be considered

Increased intracranial pressure

(neurologic evaluation)

- causes horizontal diplopia and inturning of the affect eye

- can develop from increased intracranial pressure

- most cases involve microvascular infarctions from diabetes mellitus

CN VI paralysis

- causes vertical diplopia and an inability to depress the involved eye when turned toward the nose

- eye normally turned upward and is slightly rotated

- objects may appear tilted and pt's tilt their heads to minimize diplopia

- most caused by diabetes microvascular infarction

CN IV paralysis

- causes horizontal AND vertical diplopia with affected eye turned down and out

- can be present with or w/o pupillary involvement

CN III paralysis

- pt's complai of eye pain or retro-orbital headache

- CN III palsy that spares pupillary function commonly due to microvascular infarction

- primary causes are

Diabetes mellitus or Hypertension

- CN III palsy that affects the pupil is usually due to compression by this

Aneurysm in the Circle of Willis (PCA, Basilar artery)

- the worst diplopia associated with this problem is found when the pt looks in the direction of the affected eye muscle

Neuromuscular disease

- if diplopia is relieved by covering one eye then it is called this

Binocular diplopia

- variable ptosis or diplopia that worsens as the day progresses and improves after the pt naps (fatigueable)

- ptosis will become more noticeable by having the pt maintain upward gaze

- Tensilon (cholinesterase inhibitor edrophonium) is used to treat some pt's

Ocular myasthenia gravis

- causes mild ptosis of the upper eyelid and miosis

- called Horner's syndrome when associated with anhidrosis

Sympathetic nerve palsy

- these types of lesions of the visual-motor cerebral cortex cause the eys to look TOWARD the side of the lesion

Destructive (infarct) lesions

- these types of lesions of the visual-motor cerebral cortex cause the eys to look AWAY from the side of the lesion

- Irritative lesion (seizure)

- brainstem and frontal lobe destructive lesions are associated with what direction of horizontal conjugate gaze loss

Ipsilateral vs contralateral respectively