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PDX neuro-ophthalmology - Flashcards

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Class:ANAT 535 - MEDICAL NEUROSCIENCE I
Subject:Anatomy
University:Loma Linda University
Term:Winter 2011
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What does the parasympathetic nervous system innervate in the eye? Pupillary constrictor fibers via CN III
what does the sympathetic NS innervate in the eye? Pupillary dilator fibrs via sympathetic nerves running to orbit
miosis Miosis (or myosis, from Ancient Greek , mein, "to close the eyes") is constriction of the pupil of the eye to less than or equal to two milimeters.
mydriasis Mydriasis is an excessive dilation of the pupil due to disease, trauma or the use of drugs.
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normal pupillary response requires following pathways: 1. perception of light by retina 2. afferent signaling to upper midbrain (bypass LGN) 3. efferent limb of light reflex carried by CNIII, ending in pupillary sphincter of the iris
normal pupil size 7mm at 10yrs 6mm at 30yrs 4mm at 80 yrs
hippus under steady illumination, normal pupil continually dilates and constricts small amounts
two components of normal pupillary response 1. direct reflex- illuminated pupil constricts 2. consensual reflex- non-illuminated pupil constricts as result of other eye b/c input synapses w/ both ipsilateral and contralateral CNIII
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normal pupil size and appearance round and equal diameter variation in size up to 1mm (simple anisocoria) in dim light size diff <0.4mm in bright light
abnormal anisocoria difference in size greater than 1mm in dim light >0.5mm in bright light
unilateral problems mechanical damage to iris CNIII palsy symp. nerve palsy pharmacologic pupillary paralysis
Is anisocoria caused by unilateral decrease in vision? NO! b/c signaling is averaged
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swinging flashlight test The swinging-flashlight test is used to help a practitioner decide whether reduced vision is due to ocular disease. -compares amt. of pupillary constriction from illuminating one eye vs. illuminating the other eye -difference -- asymmetric retinal disease or optic nerve disease (afferent pupillary defect or Marcus Gunn pupil)
Moving light from one eye to the other causes both pupils to dilate slightly? afferent pupillary defect
impaired parasymp. motor innervation to pupillary sphincter? efferent pupillary defect -direct response of non-involved eye normal but consensual response of involved eye is diminished or vice versa *CN III palsy
Argyll-Robertson pupil Argyll Robertson pupils (-AR pupils-) are bilateral small pupils that constrict when the patient focuses on a near object (they -accommodate-), but do not constrict when exposed to bright light (they do not -react- to light). -CNS syphilis (most common), MS, sarcoidosis, diabetes mellitus, lyme disease, following trauma +lesion in dorsal midbrain *(the above do NOT affect vision) *The following DO affect vision: severe retinal or optic nerve disease
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Adie's (tonic) Pupil pupil fails to immediately constrict in response to light or accommodation: takes a long time to respond -young women-benign lesion of ciliary ganglion *often associated w/ Achilles reflex on same side as pupil (Homes-Adie syndrome)
Diabetic pupils Bilateral small pupils fail to dilate normally due to symp. denervation fail to constrict normally due to parasymp. denervation
CN III palsy w/ pupil sparing Ischemic (vasa vasorum clogged) -HTN or Diabetes
CN III palsy w/ pupil affected (dilated) something pushing on it from the outside--- -tumor or aneurysm
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Horizontal diplopia 6th nerve palsy eye turned inward
Horner's syndrome Horner's syndrome or Horner syndrome is a clinical syndrome caused by damage to the sympathetic nervous system. Ptosis of 1-2 mm Miosis anhidrosis
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 What does the parasympathetic nervous system innervate in the eye?Pupillary constrictor fibers via CN III
 what does the sympathetic NS innervate in the eye?Pupillary dilator fibrs via sympathetic nerves running to orbit
 miosisMiosis (or myosis, from Ancient Greek , mein, "to close the eyes") is constriction of the pupil of the eye to less than or equal to two milimeters.
 mydriasisMydriasis is an excessive dilation of the pupil due to disease, trauma or the use of drugs.
 normal pupillary response requires following pathways: 1. perception of light by retina
2. afferent signaling to upper midbrain (bypass LGN)
3. efferent limb of light reflex carried by CNIII, ending in pupillary sphincter of the iris
 normal pupil size7mm at 10yrs
6mm at 30yrs
4mm at 80 yrs
 hippusunder steady illumination, normal pupil continually dilates and constricts small amounts
 two components of normal pupillary response1. direct reflex- illuminated pupil constricts
2. consensual reflex- non-illuminated pupil constricts as result of other eye b/c input synapses w/ both ipsilateral and contralateral CNIII
 normal pupil size and appearanceround and equal diameter
variation in size up to 1mm (simple anisocoria) in dim light
size diff <0.4mm in bright light
 abnormal anisocoriadifference in size greater than 1mm in dim light
>0.5mm in bright light
 unilateral problemsmechanical damage to iris
CNIII palsy
symp. nerve palsy
pharmacologic pupillary paralysis
 Is anisocoria caused by unilateral decrease in vision?NO! b/c signaling is averaged
 swinging flashlight testThe swinging-flashlight test is used to help a practitioner decide whether reduced vision is due to ocular disease.
-compares amt. of pupillary constriction from illuminating one eye vs. illuminating the other eye
-difference -- asymmetric retinal disease or optic nerve disease (afferent pupillary defect or Marcus Gunn pupil)
 Moving light from one eye to the other causes both pupils to dilate slightly?afferent pupillary defect
 impaired parasymp. motor innervation to pupillary sphincter?efferent pupillary defect
-direct response of non-involved eye normal but consensual response of involved eye is diminished or vice versa
*CN III palsy
 Argyll-Robertson pupilArgyll Robertson pupils (-AR pupils-) are bilateral small pupils that constrict when the patient focuses on a near object (they -accommodate-), but do not constrict when exposed to bright light (they do not -react- to light).
-CNS syphilis (most common), MS, sarcoidosis, diabetes mellitus, lyme disease, following trauma
+lesion in dorsal midbrain
*(the above do NOT affect vision)
*The following DO affect vision: severe retinal or optic nerve disease
 Adie's (tonic) Pupilpupil fails to immediately constrict in response to light or accommodation: takes a long time to respond
-young women-benign lesion of ciliary ganglion
*often associated w/ Achilles reflex on same side as pupil (Homes-Adie syndrome)
 Diabetic pupilsBilateral
small pupils
fail to dilate normally due to symp. denervation
fail to constrict normally due to parasymp. denervation
 CN III palsy w/ pupil sparingIschemic (vasa vasorum clogged)
-HTN or Diabetes
 CN III palsy w/ pupil affected (dilated)something pushing on it from the outside---
-tumor or aneurysm
 Horizontal diplopia6th nerve palsy
eye turned inward
 Horner's syndromeHorner's syndrome or Horner syndrome is a clinical syndrome caused by damage to the sympathetic nervous system.

Ptosis of 1-2 mm
Miosis
anhidrosis
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