They are pupillary react disorder

1. PUPILLARY REACTION
DISORDERS
By- Raju Rathore

2. HIPPUS01
• It is seen in multiple sclerosis.
• It is characterised by alternate large rhythmic
pupillary
dilatation and constriction. It is often independent
of the light
stimulation.

3. MARCUS GUNN PUPIL (OR RELATIVE AFFERENT
PUPILLARY DEFECT—RAPD)
02
• It is seen in unilateral optic neuritis, retrobulbar neuritis or
multiple sclerosis.
• It is due to lesion in one of the optic nerves (Fig. 6-5).
• It is a pupillary reflex disorder characterised by smaller
constriction of both the pupils when light is focused on the
affected
eye.
• It is diagnosed by swinging flash light test. The test is
done
in a darkened room with the patient fixating at a distant
target.
On swinging a light from one eye to the other, stimulation of

4. 02 However, rapid stimulation of the affected eye will lead to a
small dilatation which is also known as pupillary escape

5. ADIE’S PUPIL (OR TONIC PUPIL)03
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• It is usually an unilateral (in 80% of cases) dilated but
tonic
pupil (anisocoria).
• It is called “Adie’s pupil”, if the cause is not identified.
However, it is termed as “Tonic pupil” if the aetiology is
detected

6. 02
• Etiology includes; viral infection of the ciliary ganglion or
the
short ciliary nerve (Fig. 6-5), injury to the ciliary ganglion
or
the short ciliary nerve, giant cell arteritis, syphilis, diabetes
mellitus, herpes zoster, orbital infection, etc.
• Bilateral Adie’s pupil is often seen in association with
syphilis
and sarcoidosis.
• Very poor pupillary light reflex response (both direct and
consensual).

8. ARGYLL–ROBERTSON PUPIL
• It is characterised by absence of pupillary
reaction to light
reflexes (both direct and consensual) and
retention of pupillary reaction on accommodation
and convergence (near reflex), i.e.
pupillary light near dissociation.
• The pupils are small and usually unequal.
• Vision is unaffected.

10. HORNER’S SYNDROME
• It is characterised by unilateral miosis, partial
ptosis, slight
elevation of the lower lid, enophthalmos and
heterochromia (in
congenital variety).
• It is occasionally accompanied by unilateral
absence of sweating
of the face (anhidrosis) and flushing of the face.

12. THANK YOU