Post on 21-Jan-2016
description
Neuro-Ophthalmology DivisionNeuro-Ophthalmology Division
Department of Ophthalmology and Visual ScienceDepartment of Ophthalmology and Visual Science
VA and University Hospital, Iowa City, Iowa VA and University Hospital, Iowa City, Iowa
Causes of an Irregular Pupil
the iris tissue itself – muscle and stroma
nerve causes – segmental denervation or aberrant re-innervation of either parasympathetic or sympathetic nerves
central nervous system (rare) – midbrain “corectopia” and brainstem herniation
Iris Causes of an Irregular Pupil
Rieger’s ICE
ICEAxonfeld’s/Rieger’s
Sphincter tearsIschemia
ZosterPost surgical
ColobomaIris Synechia
Ectropian UveaeIris Tumor/Cyst
The iris tissue itself – muscle and stroma
Nerve Causes of an Irregular Pupilpostganglionic sympathetic denervation of the iris dilator
light
dark 3 seconds
dark 8 seconds
Nerve Causes of an Irregular Pupilpostganglionic sympathetic denervation of the iris dilator
and aberrant re-innervation of some dilator sectors
light
dark 5 seconds
in dark, “swallowing”
Nerve Causes of an Irregular Pupilpostganglionic sympathetic denervation of the iris dilator
and aberrant re-innervation of some dilator sectors
light
dark 5 seconds
video in dark, swallowing cold water
Nerve Causes of an Irregular Pupilsegmental sympathetic pulling on the dilator
“tadpole pupil”
Nerve Causes of an Irregular Pupilsegmental sympathetic pulling on the dilator
tadpole pupil video
Dark
Bright Light
Near
Chronic “Little Old Adie’s Pupil”
Nerve Causes of an Irregular Pupilabnormal parasympathetic innervation to the sphincter
Infraredtransillumination
Infraredfront illumination
Dark
Near
0.5%tropicamide
CNS Causes of an Irregular Pupil
Midbrain “Corectopia”Selhorst et al, Arch Neurol 33,193, 1976
The oval pupil: relationshipto intracranial hypertension
Marshall et al, J Neurosurgery 58:566-568. 1983
brainstem herniation
rare
Causes of an Irregular Pupil
the iris tissue itself – muscle and stroma
nerve causes – segmental denervation or aberrant re-innervation of either parasympathetic or sympathetic nerves
central nervous system (rare) – midbrain “corectopia” and brainstem herniation