![]() ![]() Platelet count, erythrocyte sedimentation rate, and C-reactive protein were within normal limits. He had no other giant cell arteritis symptoms. A 68-year-old man with new headache was referred to the emergency eye clinic from the general emergency department to rule out giant cell arteritis. Prognosis and complications are individually assessed for the specific pupillary abnormality and its etiology. Because the parasympathetic system innervates the ciliary muscle, which governs accommodation, as well as the iris sphincter muscle, which governs pupil size, patients with oculomotor nerve palsy or short ciliary nerve damage may report blurred near vision while reading. Occasionally, patients may complain of photophobia in the eye with a large (mydriatic) pupil because increased light reaches the retina through the wider aperture. Often pupillary abnormalities are asymptomatic or noticed only by an observer. The abnormality may be transient or constant. Abnormally positioned pupil (corectopia) Afferent: relative afferent pupillary defect.There are several major types of pupil abnormalities: Many contributions to our understanding of pupillary physiology and pathology were made in the 20th century, including the description of the swinging flashlight test for assessing a relative afferent pupillary defect ( 48). It was not until the first half of the 18th century that it became widely accepted that iris movement and pupil size were due to active interaction of 2 iris muscles: a longitudinal radial dilator and a circular sphincter muscle. The miotic pupil of Horner syndrome should be recognized and confirmed with topical apraclonidine testing.Īround 200 A.D., Galen likened the iris to an elastic circular ring that was passively inflated or deflated by vital spirits sent from the brain to enhance vision.The mydriatic pupil of oculomotor palsy must be distinguished from “isolated” pupil disturbances, including tonic (Adie) pupil and pharmacologic and traumatic (including intraocular surgery) mydriasis.The pupil examination includes: (1) swinging flashlight test to determine the presence of a relative afferent pupillary defect and (2) measurement of pupil size in dim illumination and constriction to light and a near target. ![]() A “low tech” algorithm leads the clinician through the evaluation process to know whether the patient can be reassured or needs additional testing. ![]() The author discusses causes of anisocoria and abnormal pupillary activity. Does the patient have an aneurysm or is it just physiologic anisocoria? The pupil exam is to the eye what the deep tendon reflexes are to the neurologic exam: an objective and easily elicitable measurement. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |