Dr. S. SoundariConsultant ophthalmologist

Dr Agarwal’s eye hospital, chennai

DILATED PUPIL CONSTRICTED PUPIL

Well appreciated in bright light

Causes RAPD

ADIES

TRAUMATIC

THIRD NERVE PALSY

PHARMACOLOGICAL

Well appreciated in dim light

CausesHORNERS

ARGYLL ROBERTSON PUPIL

PHARMACOLOGICAL

Bilateral Optic nerve pathology

Normal- 840msec

Abormal: Difference between two pupils-

70msec More than 954 msec

Large unilaterally dilated pupil

Absent or poor light response

Near slow tonic contraction

Absence of deep tendon reflex- home’s adies syndrome.

EOM affected

Can be Pupil involving or Pupil sparing

Pseudoargyll robertsons pupil

Pupillary constriction on looking down

Does not respond to 2% pilocarpine as the receptors are blocked

Example: atropine, homatropine,cyclopent

Miosis

Partial ptosis

Inverse ptosis

Enophthalmos

Anhydrosis

Loss of ciliospinal reflex

Hetrochromia Iridis

Low IOP

Normal pupil dilates Horners pupil does not

Mechanism- prevents re-uptake of norepinephrine

PREGANGLIONIC Dilates

Mechanism- releases the norepinephrine

POSTGANGLIONIC Dilates

Mechanism- denervation supersentivity

Both pupil miotic assymmetric

Light reflex absent

Accomodation reflex present

Causes: Argyll Robertson Pupil

Adies Pupil

Diabetes

Alcoholism

Parinauds Syndrome

ECCENTRIC PUPIL ICE SYNDROME