2. Pupil Responses

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  1. How do pupil reactions change with age?
    • smaller
    • less reactive to light
    • more difficult to dilate
    • increase in dof
    • increase diffractive elements
    • reduce fundus illumination
  2. What kind of fibres innervate sphincter muscle?
  3. What kind of fibres innervate dilator muscle?
  4. Afferent pathway of pupil light reflex?
    RGC-> ON -> OC -> OT -> Pretectal nucleus -> EW Nucleus
  5. Efferent pathway of pupil light reflex: parasympathetic?
    EW nucleus + Accommodation fibres-> C3 -> Ciliary ganglion -> Short ciliary nerve -> Ciliary body and iris sphincter muscle
  6. Efferent pathway of pupil light reflex: sympathetic?
    Hypothalamus -> Spinal cord -> Superior cervical ganglion -> C5 -> Long ciliary nerve -> Dilator muscle
  7. RAPD?
    • relative afferent pupil defect
    • afferent pathway (RGC->OC) is damaged/affected
    • light will not induce full pupillary light reflex
  8. What happens in the swinging light test with RAPD
    • RE affected, 
    • light moved from LE to RE:, LE orignally constricted, RE will dilate, LE will dilate
  9. What is an argyll Robertson pupil?
    • both pupils small
    • no direct/consensual response
    • near response ok
  10. What is the etiology of an Argyll Roberson pupil?
    • damage to parasympathetic pathway
    • possible: neurosyphilis lesion near EW nucleus- affects dorsal pupillary fibres (responds to light)
    • spares ventral pupillary fibres (accommodation)
  11. What are some diagnostic tests for neurosyphilis?
    • VDRT: veneral disease research test
    • FTA-ABS
    • RPR: rapid plasma reagin
    • TPPA
  12. Adie's tonic pupil?
    • Postganglionic para denervation of ciliary muscle and spinchter
    • neuronal loss in short ciliary nerves/ ciliary ganglion
  13. Features of an adie's tonic pupil?
    • unliteral, f>m
    • affect eyes is dilated and cons/dir poor
    • near strong but slow
    • constricts to 0.125%pilocarpine
    • vermiform movements
  14. Horner's etiology?
    • damage to sympathetic pathway
    • pupillodilator dysfunction
  15. Sx of horners?
    • ptosis
    • unilateral miosis
    • facial anhydrosis
    • pupil reactions normal
  16. Diff between acq and congenital horners?
    • congenital: heterochromia
    • acquired: neck trauma, hypo haem/tumour, lunch cancer, cavernous sinus lesion, carotid artery dissection
  17. Test for horners?
    • apraclonodine: affected eye will dilate
    • cocaine: unaffected eye will dilate
Card Set:
2. Pupil Responses
2013-11-05 12:39:20

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