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Anisocoria

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pupil , its size and evaluation in different light condition

Publicada em: Saúde e medicina
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Anisocoria

  1. 1. DR.PRIYANKA CHOUDHARY JR-2 OPHTHALMLOGY DEPT MODERATOR:-DR.ABHA SHUKLA ASST. PROFF DEPT OF OPHTHALMOLOGY
  2. 2.  Size 3-4mm  Muscles controlling pupil Sphincter pupillae Dilator pupillae
  3. 3.  AFFERENT FIBRES- these fibres extend from retina to pretectal nucleus in midbrain  RODS AND CONES GANGLION CELLS OPTIC NERVE CHIASMA PRETECTAL NUCLEUS INTERNUNCIAL FIBRES Pretectal nucleus to EWN.
  4. 4.  parasympathetic ganglion.  The oculomotor nerve coming into the ganglion contains = preganglionic axons from the EWN which form synapses with the ciliary neurons. =The postganglionic axons run in the short ciliar nerves and innervate two muscles: sphicter pupliae, ciliaris( accommodation) muscles are involuntary – they are controlled by the ANS. HAS THREE ROOTS  parasympathetic root of ciliary ganglion originating from Edinger westphal nucleus (or motor root)  a sympathetic root of ciliary ganglion from internal carotid plexus  a sensory root of ciliary ganglion DISEASES  Adie tonic pupil  Adie syndrome[ (tonic pupil plus absent deep tendon reflexes).  Light-near dissociation(no reaction of pupil to light but reaction to accomodation present)
  5. 5.  AFFERENT FIBRES- these fibres extend from retina to pretectal nucleus in midbrain  RODS AND CONES GANGLION CELLS OPTIC NERVE CHIASMA PRETECTAL NUCLEUS INTERNUNCIAL FIBRES Pretectal nucleus to EWN.
  6. 6.  Consists of parasympathetic fibres which arise from EWN and travel along 3RDnerve.  Preganglionic fibres enter the inferior division of 3RD nerve and via the nerve to IO and relay in ciliary ganglion.  Postganglionic fibres travel along short ciliary nerves and supply sphincter pupillae
  7. 7.  Difference between the size of two pupil. TYPE OF ANISOCORIA  1.PHYSIOLOGIC ANISOCORIA:- 1. Simple/central/essential 2. Minimal anisocoria [<0.4mm] 3. Both pupils react well to light 4. No dilatation lag 5. Isolated condition
  8. 8. 2.MIOSIS OF ONE PUPIL  Effect of local miotic drug  Effect of systemic morphine  Iridocyclitis  Horner’s syndrome  Head injury  Effect of strong light 3.MYDRIASIS OF ONE PUPIL  Effect of topical sympathomimetic drug  Effect of topical parasympatholytic drug  Sphincter damage  Internal ophthalmoplegia  Third nerve paralysis  Belladona poisoning
  9. 9.  Difference in pupil size >2mm is considered pathological and warrants further evaluation.  Anisocoria is not caused by optic nerve or afferent pupil pathway dysfunction.  Assuming sphincter is structurally normal on slit lamp examination, anisocoria is a sign of autonomic dysfunction.  A pupil with a brisk sustained light reflex is a normal pupil whether or not it appears larger or smaller than its fellow  In case pupil which is constricted or dilated,check for consensual reflex in the other pupil.presence of consensual reflex indicates integrity of afferent system in that eye is normal
  10. 10. POSTGANGLIONIC- postganglionic fibres in the head Causes- benign vascular headache syndrome , head trauma, intraaural or retro parotid trauma and cavernous sinus lesion CENTRAL- hypothalamus to the ciliospinal centre of budge at C8-T2 Causes- brainstem vascular lesions,demyeli nation and tumors,syringo myelia and spinal cord lesions at C8-T2 PREGANGLIONIC- C8-T2 of spinal cord to the course of preganglionic fibres to the superior cervical ganglion Causes- pancoast’s tumor , carotid and aortic aneurysm, malignant cervical lymph nodes , congenital (birth trauma) Oculosympathetic paresis 3 TYPES
  11. 11. CLINICAL FEATURES 1. Ptosis 2. Apparent enopthalmos 3. Miosis 4. Dilatation lag 5. Facial anhydrosis 6. Heterochromia iridis
  12. 12.  Tonicity caused by damage to ciliary ganglion or short ciliary nerves (postganglionic parasympathetic nerve injury) Characterised by-  Sectoral iris sphincter palsy  Poor reaction to light  Denervation cholinergic supersensitivity  Strong and tonic response to near vision i.e light –near dissociation followed by slow redilation  Idiopathic tonic pupil-adies pupil  70% patients are female
  13. 13.  Accomodative paresis  Difficulty refocussing for distance
  14. 14.  Neurosurgical emergency  Complete/partial palsy with or without pupil involvement  Complete/partial ptosis which may mask diplopia  Clinical presentation depends on location of dysfunctionalong pathway between 3rd nerve nucleus in midbrain and its branches of 3rd nerve  Diagnosis is critical if pupil is involved

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