Amaurotic, Pupillary Defects


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Amaurotic, Pupillary Defects

  1. 1. Manila Central UniversityPupillary DisordersOT 2-1 Group 5
  2. 2. OPTO 101, Physiological Opticsamaurotic pupilAbstractPupillary abnormalities range from benign isolated findings to harbingers of significant, even life‐threatening, conditions. Acomplete understanding of the neuroanatomy underlying the innervations to the antagonistic pupillary sphincter and dilatormuscles is essential to detecting, and discerning the importance of, a particular pupillary abnormality. The sphincter musclereceives neuronal input from the parasympathetic division of the autonomic nervous system, whereas the dilator musclereceives input from the sympathetic division. Afferent input carrying light information to the brain is transmitted by retinalganglion cell axons via the optic nerves, chiasm, and tracts. The parasympathetic innervation to the pupil originates in theEdinger‐Westphal nucleus in the midbrain. The sympathetic innervation to the pupil consists of a three‐neuron pathwayoriginating in the hypothalamus. Important pupillary disorders include physiologic anisocoria, relative afferent pupillary defect,amaurotic pupil, Argyll Robertson pupils, cranial nerve III palsy, pharmacologic mydriasis, tonic pupil, and Hornersyndrome.Amaurotic pupillary defect is the term applied to an eye that does not even see light owing to severe unilateral retinal oroptic nerve disease. Obviously, a blind eye would not have a direct light response, nor could it induce a consensual responsein the normal eye. However, a light shown directly into the normal eye would induce a direct response there and aconsensual response in the blind eye. Amaurotic pupillary response.Pupillary Disorders 1
  3. 3. OPTO 101, Physiological OpticsHistoryAmaurotic pupil. An eye having an amaurotic pupil (having no light perception) will have no direct pupillary reflex but willcontract consensually when the fellow (normal) eye is stimulated by light. The fellow eye, when stimulated, will react to lightbut will not react consensually when the amaurotic eye is stimulated. The near reflex will be present for both eyes.TestAmaurotic pupillary reaction:We swing the light from the diseased eye to normal eye to the diseased eye again. We find lost direct, normal indirect andunsustained direct light reflexes.This occurs in cases of unilateral complete damage of retina or optic nerve (no PL) while motor pathway is intact. Examplesare:- Unilateral complete optic atrophy.- CRAO.- Unilateral absolute glaucoma.- Old standing retinal detachment or CRAO with complete retinal atrophy an no PL.Abnormal Pupils:Amaurotic, "blind eye," with no light perception as a result of an optic nerve lesion. A.) Pupils are of equal size. B.) Neither pupil reacts when the defective eye is stimulated. 1.) There is no direct light response. 2.) There is no consensual light response to the contralateral eye. C.) Both pupils react when the contralateral eye is stimulated. 1.) Direct light response is present. 2.) Consensual light response is present. D.) Near reflex is normal.Symptomsabsolute afferent pupillary defect:Blind eye has no direct reaction to lightBoth pupils are equal in sizeDoes react consensuallyNormal eye has a good direct reaction to light Does not react consensuallyNear reflex is normal in both eyesManagementNo immediate treatment of proven benefitPupillary Disorders 2
  4. 4. OPTO 101, Physiological OpticsTermsCRAO, or Central Retinal Artery Occlusion is a condition in which there is irreversible damage to the retinal rods and cones,cells which process light into electrical stimulus for the brain to understand, as a result of complete stoppage of blood flow.Within 6 hours, the retina becomes damaged, if immediate measures are not taken to prevent full stoppage of blood supply.The cause usually is a problem with the heart or blood vessels supplying blood to the eye. Factors which can increase therisk for CRAO are pregnancy, high cholesterol, obesity, diabetes, hypertension, and some medicines like oral contraceptivepills. The cardiologist has to enquire into great detail for such history and investigate accordingly. This is to prevent suchepisode from occurring in the other eye or brain.PERRLA pupils equal, round, and reactive to light and accommodation.Optic Nerve Disease – Damage to the optic nerve typically causes permanent and potentially severe loss of vision, as well asan abnormal pupillary reflex, which is diagnostically important.The type of visual field loss will depend on which portions of the optic nerve were damaged. In general: • Damage proximal to the optic chiasm causes loss of vision in the visual field of the same side only. • Damage in the chiasm causes loss of vision laterally in both visual fields (bitemporal hemianopia). It may occur in large pituitary adenomata. • Damage distal to the chiasm causes loss of vision in one eye but affecting both visual fields: The visual field affected is located on the opposite side of the lesion.GROUP 5 PRESENTER:CARL JOSELLE R. CAPULONGMACLESTER MANAHANENRICO M. ABESAMISHANCEL M. DARROCASIGFRED AOASJOVELYN CANETESNEHAL THAPAALLEN HUBERT UY LIMPupillary Disorders 3