Pupillary react disorders
- 1. PUPILLARY REACTION DISORDERS By- Raju Rathore
- 2. HIPPUS01 • It is seen in multiple sclerosis. • It is characterised by alternate large rhythmic pupillary dilatation and constriction. It is often independent of the light stimulation.
- 3. MARCUS GUNN PUPIL (OR RELATIVE AFFERENT PUPILLARY DEFECT—RAPD) 02 • It is seen in unilateral optic neuritis, retrobulbar neuritis or multiple sclerosis. • It is due to lesion in one of the optic nerves (Fig. 6-5). • It is a pupillary reflex disorder characterised by smaller constriction of both the pupils when light is focused on the affected eye. • It is diagnosed by swinging flash light test. The test is done in a darkened room with the patient fixating at a distant target. On swinging a light from one eye to the other, stimulation of
- 4. 02 However, rapid stimulation of the affected eye will lead to a small dilatation which is also known as pupillary escape
- 5. ADIE’S PUPIL (OR TONIC PUPIL)03 ENTER TITLE ENTER TITLE ENTER TITLE • It is usually an unilateral (in 80% of cases) dilated but tonic pupil (anisocoria). • It is called “Adie’s pupil”, if the cause is not identified. However, it is termed as “Tonic pupil” if the aetiology is detected
- 6. 02 • Etiology includes; viral infection of the ciliary ganglion or the short ciliary nerve (Fig. 6-5), injury to the ciliary ganglion or the short ciliary nerve, giant cell arteritis, syphilis, diabetes mellitus, herpes zoster, orbital infection, etc. • Bilateral Adie’s pupil is often seen in association with syphilis and sarcoidosis. • Very poor pupillary light reflex response (both direct and consensual).
- 8. ARGYLL–ROBERTSON PUPIL • It is characterised by absence of pupillary reaction to light reflexes (both direct and consensual) and retention of pupillary reaction on accommodation and convergence (near reflex), i.e. pupillary light near dissociation. • The pupils are small and usually unequal. • Vision is unaffected.
- 10. HORNER’S SYNDROME • It is characterised by unilateral miosis, partial ptosis, slight elevation of the lower lid, enophthalmos and heterochromia (in congenital variety). • It is occasionally accompanied by unilateral absence of sweating of the face (anhidrosis) and flushing of the face.
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