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57 Cards in this Set

  • Front
  • Back
Constriction of pupils results from stimulation of what system? or blockage of what system?
What is the pupil formed from?
Uveal tract: iris, ciliary body, choroid
Dilation of pupils results from stimulation of what system? or blockage of what system?
Stimulation: SNS
Blockage: PNS
What gives nutrition to the eye and has the most relative blood flow of any organ in the body?
What are the 2 muscles of the iris?
Sphincter (along inner border of pupil), and dilator (along outer border of pupil)
What does hippus mean?
2 muscles in iris, sphincter & dilator, are never at rest...that means that the pupil is always getting larger and smaller.
What is the main function of pupil?
Allows eye to receive more or less light depending upon its needs, but also provides very useful diagnostic information.
What controls the sphincter muscle?
When the pupillary reflex is stimulated by increased light, what does the anatomical course include?
Pupil-->retina-->optic nerve-->optic tract-->posterior brain-->CN III-->Superior ciliary ganglion in orbit-->activates sphincter muscle-->constriction of pupil
What are 2 drugs that are PNS blockers?
Atropine, and Scopolamine
What drug will affect the eye for up to 10 days?
What controls the dilator muscle?
What is the anatomical course of the SNS?
Hypothalamus-->ipsilateral spinal cord-->exits cord around T1-->course around the apex of lung-->under subclavian artery and around carotid artery-->synapses and continues to areas of brain, eye and Muller's muscle of eyelids-->dilation of pupils and opening of eye slightly.
What 2 SNS stimulators are useful for testing in Horner's syndrome?
Cocaine, Phenylephrine
What types of irises are much more sensitive to dilation?
Lighter colored irises are much more sensitive to dilation.
What do red-topped bottles do?
Cause dilation of the pupil.
What are the important contraindications to dilation?
2.History suspicious for angle closure (high risk: elderly, eskimos, Asians, females, hyperopic/farsighted pts, positive family hx of angle closure)
3.Glaucoma post cataract surgery-square pupil or those with a pupil-fixated intraocular lens
4.Acute neurological patient
If your unsure whether a pt. is hyperopic, what test should you do?
Shine a pen light parallel to the iris.
When a pen light is shined parallel to the iris, what does a shadow indicate?
A shadow indicates a shallow anterior chamber and an increased risk for angle closure-don't dilate!
What is schiotz tonometer or tonopen used for?
Used to measure IOP.
When examining the pts eyes, where should they be focusing?
On a distant target.
How are the speeds of the direct and consensual responses graded?
0 (no response)-4 (brisk response)
When a patient looks at your finger close to their nose, what can you determine?
Accomodation (focus), constriction of pupils, and adduction of eyes.
What are the 2 things that trauma may lead to?
2.change in pupil size or shape (may see "ovaling")
Unilateral miosis/mydriasis can be caused by what?
Medication/drug use or abuse.
A pt. using a scopolamine patch may have inadvertently touched the patch and then his eye....what happened to his eye?
Pupil dilation and blurry vision.
In what disease will the eye be injected (red eyes) upon examination will small pupil on affected side? Pt. will complain of photophobia and trouble seeing.
In this eye disease, the pupil will be small and pt will complain of intense photophobia. Also, the patient will have the classic dendritic shape visible in the eye.
Herpes Simplex Infection
This type of eye disease may severly affect pupillary findings, especially if the infection penetrates through the anterior chamber.
Bacterial infection
What type of eye disease might cause hypopia and misshapen pupil due to accumulation of inflammatory cells?
Internal infection.
In what eye disease will the pupil be bound down to the fibrin membrane? Pupil will likely be misshapen and pt will be miserable with no Sx aside from eye complaints (so you know the problem is local and not systemic)
Excessive internal inflammation.
Eye injected with mid-size, non-reactive pupil due to intense pressure elevation. Pt. will be miserable and complain of vision problems. This condition may be iatrogenic if a pt with a shallow anterior chamber is given medication to dilate their pupil.
What will one see with a pre-operative cataract?
Cloudy layer over pupil.
What will one see with a post-operative cataract?
May see square pupil due to iris-fixated lens.
What is a white reflex called?
A leucocoria seen during a pediatric rotation is most likely what?
During an eye exam, how will a prosthesis appear?
Blurred light reflex in the prosthetic eye and it won't be reactive to light.
You have a pt. with a small pupil and a red eye....what should you be thinking?
Non-infectious inflammation leading to iritis (small pupil with red hot eye) and pain. May result in lesions of the eye. Affects primarily Black and Hispanic people. What systemic disease?
What is rubeosis?
Abnormal growth of blood vessels in iris.
What systemic disease may cause rubeosis, which may inhibit dilation?
What is the Argyll-Robinson pupil response?
When both pupils looks fine, but the affected eye is unresponsive to light.
What is the Argyll-Robinson pupil response also known as?
Light-near dissociation.
Treatment of what systemic disease will lead to light-near dissociation?
Peripheral Diabetic Neuropathy.
What is a major etiology of optic neuritis?
What does CN III palsy result in?
Fixed dilated pupil and pt. will not be able to open the eyelid.
If there is a CN III palsy, what will the pupil respond to?
Pupil WILL respond to (higher dose) 1% pilocarpine.
If scopolamine is responsible for a CN III palsy, what will the symptoms not be alleviated by?
Anisocoria of equal amt in light and dark associated with "white eye" and NOT associated systemic symptoms in a healthy individual=??
Physiololgic Anisocoria
In what type of pupil...can't tell the difference between an atomic flash and midnight in a coal mine?
Amaurotic Pupil
Results from optic nerve disease. It is diagnosed with the "swinging flashlight test" which demonstrates paradoxical enlargement of the affected pupil when exposed to light. What pupil?
Marcus Gunn Pupil
This is a classic "blown pupil" that presents with a fixed dilated pupil. This results from CN III palsy due to brain pathology and is seen only in a sick patient.
Hutchinson Pupil
Is a large, flaccid pupil that usually occurs in healthy young females. Use 1/8% pilocarpine to diagnose (miosis=positive test)
Adies Tonic Pupil
Pupil is small, has vision and will react to near (accomodation) but not to light--"light-near dissociation." It's like a prostitute, it can accomodate but there's no reaction.
Syphilitic Argyll-Robertson

(Physiologic or Pathologic)
Marcus Gunn Pupil

Aka – Relative afferent pupillary defect (RAPD)

“Can’t tell the difference between an atomic blast or midnight in a coal mine”
Horner’s Syndrome
Hutchinson Pupil
Adie’s Tonic Pupil