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The first 25 slides, exactly as they appear. The full deck has 71 content slides.
Ophthalmology
Disorders of Pupil
Built from Khurana — Neuro-Ophthalmology
What’s inside
8 sections · 71 slides
Overview
- What this topic covers
Shape, Position and Size
Morphological abnormalities and unequal pupils
- Pupils in the wrong place or too many
- Anisocoria - the two pupils are unequal
- Physiological (simple) anisocoria
- Which pupil is abnormal - the small or the large?
- Using the light to find the guilty pupil
- Reading anisocoria by the light reflex
Afferent Pathway Defects
When the 'there is light' signal fails to arrive
- Splitting the light reflex into two arms
- Total afferent pathway defect (amaurotic pupil)
- Relative afferent pathway defect (Marcus Gunn pupil)
- Wernicke's hemianopic pupil
Efferent Pupillary Defects
When the 'now constrict' command cannot get out
- What an efferent defect looks like
- Common causes of efferent defects
- Tonic pupil - a slow, denervated pupil
- Causes of a tonic pupil
- Telling apart the fixed dilated pupil: three suspects
- The pilocarpine test - how it is done and read
- Evaluating a parasympathetic palsy at the slit lamp
Light-Near Dissociation
A pupil that reacts to near effort but not to light
- What light-near dissociation means
- Causes of light-near dissociation
- Mechanisms of light-near dissociation
- Argyll Robertson pupil
Horner's Syndrome
Sympathetic paresis: a three-neuron chain that can fail anywhere
- Sympathetic supply - three neurons in series
- The three-neuron oculosympathetic pathway
- Three types of Horner's syndrome by lesion site
- Clinical features of Horner's syndrome
- Localising the lesion by the company it keeps
- Horner's drug tests: cocaine and hydroxyamphetamine
- The adrenaline / phenylephrine test
- Cocaine versus hydroxyamphetamine test
Clinical Examination of the Pupil
Measuring size and testing every reflex
- Measuring pupil size
- Measuring pupil size in both eyes together
- Why optic-nerve disease never causes anisocoria
- Why a 50% afferent defect still leaves equal pupils
- Shape and colour of the pupil
- Testing the direct light reflex
- Choosing the light source for pupil testing
- Directing the light from below and temporally
- Testing the consensual light reflex
- Observing the consensual reflex in a dark iris
- Kestenbaum's pseudo-anisocoria test
- Kestenbaum's pseudo-anisocoria test
- The swinging-flashlight test
- The swinging-flashlight test, step by step
- A common pitfall - the 'dark period' false negative
- How a slow swing hides a mild RAPD
- Grading and quantifying the RAPD
- Quantifying the RAPD with neutral-density filters
- Interpreting the RAPD and its traps
- Swinging-flashlight test in special situations
- Swinging-flashlight test with only one usable pupil
- False-positive test in strabismus
- The 'tilt' test for a subtle RAPD
- Edge-light pupil cycle time (ELPCT)
- Edge-light pupil cycle time at the slit lamp
- Testing the near reflex
- Near reflex in a blind patient, and the dark reflex
- The ciliospinal reflex
Summary and Self-Test
- The whole chapter in three ideas
- Key take-home points
- A patient has a fixed, moderately dilated pupil. How do you sort out the cause with pilocarpine?
- References
- Neuro-Ophthalmology