if you see ptosis with miosis/anhydrosis?
what about ptosis with a dilated pupil?
what about segmental contraction of the pupil
Horners syndrome - complete lack of sympathetic tone. 10% cocaine wont help you, cocaine is a norepi reuptake inhibitor, but no norepi at the jxn
CN3 palsy - with levator, may have other deviation on EOM.
Adie's tonic pupil - dilated pupil that doesnt respond in light - due to damage to the parasympathetic innervation from trauma/infection(viral/bac) etc.
If the difference in size is greater in the dark, the smaller pupil is abnormal. causes -Horner syndrome and physiologic anisocoria. differentiate -the small pupil in Horner syndrome does not dilate after instillation of an ocular dilating drop (eg, 10% cocaine).
If the difference in pupillary sizes is greater in light, the larger pupil is abnormal. If extraocular movements are impaired, particularly with ptosis, 3rd cranial nerve palsy is likely. If extraocular movements are intact - further differentiate among causes by instilling a drop of a pupillary constrictor (eg, 0.1% pilocarpine). If the large pupil constricts, the cause is probably Adie tonic pupil; if the large pupil does not constrict, the cause is probably drugs or structural (eg, traumatic, surgical) damage to the iris.