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Pupil abnormalities
Neuro-Ophthalmology
Key Points
- •RAPD is detected by the swinging flashlight test; the affected pupil paradoxically dilates - it indicates unilateral or asymmetric optic nerve/retinal disease (NOT cataract or refractive error)
- •Adie tonic pupil: young woman + dilated pupil + light-near dissociation + tonic redilation + constricts to dilute pilocarpine 0.125% (denervation hypersensitivity)
- •Argyll Robertson pupil: bilateral, small, irregular, light-near dissociated pupils pathognomonic of neurosyphilis - 'accommodates but does not react'
- •Horner syndrome: miosis + ptosis + anhidrosis; all acute postganglionic Horner requires URGENT carotid imaging to exclude dissection
- •Approach to anisocoria: greater in light → large pupil abnormal (parasympathetic); greater in dark → small pupil abnormal (sympathetic/Horner)
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Keep reading Pupil abnormalities
17 more sections are included with the Clinical plan.
- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Risk factors and associations