Book chapter
9.20 - Pupillary Signs of Neuro-ophthalmic Disease
Ophthalmology, pp.902-910
Elsevier Inc, Sixth Edition
2023
DOI: 10.1016/B978-0-323-79515-9.00165-1
Abstract
This chapter discusses the neuroophthalmic aspects of the pupils. The pupil examination can provide information on the etiology of vision loss and also help identify neurological disorders that could potentially be life-threatening. The first section discusses the relative afferent pupillary defect. The presence of a relative afferent pupillary defect indicates that there is asymmetric light input coming from one eye and typically signifies that there is damage to the optic nerve or retina. This is best measured using the swinging flashlight test and can be quantified with neutral density filters. The second section discusses anisocoria, which is the presence of unequal-size pupils. This can be a benign phenomenon, such as physiological anisocoria, which is seen in 20% of the healthy population. However, anisocoria can also be caused by Horner’s syndrome or third nerve palsy, which can be associated with neurologically dangerous etiologies. When approaching anisocoria, the first step is to determine whether the anisocoria is more prominent in light or dark conditions. Horner’s syndrome and sometimes physiological anisocoria are more prominent in dark conditions, while Adie pupil and third nerve palsy are more prominent in light conditions. Careful examination for ptosis and abnormalities in extraocular movements should be part of the examination of anisocoria. Confirmatory eye drop tests can be done for suspected Horner’s syndrome or Adie’s syndrome. The significance of light-near dissociation is also discussed. The chapter concludes with a discussion of melanopsin-containing retinal ganglion cells, which are the retinal cells responsible for the pupillary light reflex.
Details
- Title: Subtitle
- 9.20 - Pupillary Signs of Neuro-ophthalmic Disease
- Creators
- John Jing-Wei ChenRandy H. Kardon
- Resource Type
- Book chapter
- Publication Details
- Ophthalmology, pp.902-910
- Edition
- Sixth Edition
- Publisher
- Elsevier Inc; Philadelphia, PA
- DOI
- 10.1016/B978-0-323-79515-9.00165-1
- Language
- English
- Date published
- 2023
- Academic Unit
- Ophthalmology and Visual Sciences; Iowa Neuroscience Institute
- Record Identifier
- 9984419457502771
Metrics
74 Record Views