Pupil - SSJ,CALICUT MEDICAL COLLEGE

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  • DILATED IMMOBILE PUPILS
  • Pupil - SSJ,CALICUT MEDICAL COLLEGE

    1. 1. PUPIL Shruthi.s.jayaraj ,53rd
    2. 2. PUPIL • aperture of the diaphragm of eye (iris) that allows light to enter the retina FUNCTION • Controls amount of light entering the eye – influence of ANS
    3. 3. Not all animals have circular pupil !!
    4. 4. • Pupils are controlled by 2 muscles of ectodermal origin – 1. Sphincter pupillae 2. Dilator pupillae
    5. 5. • Circular fibres – parasympathetic supply – miosis • Radial fibres – cervical sympathetic nerves – mydriasis BALANCE OF TONE BETWEEN THE 2 ANTAGONIST MUSCLES MAINTAIN THE NORMAL PUPIL SIZE
    6. 6. • TONE OF SPHINCTER MUSCLE > TONE OF RADIAL MUSCLE (keeps the pupil slightly contracted ) • Pupils are equal normally on both sides unequal anisocoria
    7. 7. note 1. normally there is one pupil. More than 1 pupil is called polycoria 2.Pupil location almost central,slightly nasal..eccentric pupil is called correctopia
    8. 8. • Pupil size varies depending on the background illumination (2-3 mm normally) • Diameter affects the type of image formed Note the size,shape & contour of the pupil.then test for reflexes
    9. 9. PUPILLARY REFLEXES PUPILS PARTICIPATE IN SEVERAL REFLEXES • LIGHT REFLEXES – DIRECT,INDIRECT • NEAR REFLEX • PSYCHOSENSORY REFLEX
    10. 10. Keep in mind!! • Illumination of examination room should be low • Patient should look into the distance • Light used should be focussed & bright
    11. 11. • DIRECT & INDIRECT When light is shone in one eye,both the pupils constrict.. Constriction of pupil to which light is shone is direct light reflex and that of other is consentual ( indirect ) light reflex.
    12. 12. • Using a bright focussed light • In a dark room • Finer examination – slit lamp
    13. 13. Swinging flashlight test
    14. 14. • If both optic nerves are intact, both pupils will be tightly constricted (direct’ magnitude = concensual) If one optic nerve damaged,both pupils dilate on showing the light to the diseased eye. on swinging back to normal side,both pupils constrict
    15. 15. • The dilatation or escape that occurs is called MARCUS GUNN PUPIL or AFFERENT PUPILLARY DEFECT.
    16. 16. NEAR REFLEX OCCURS ON LOOKING AT A NEAR OBJECT. IT HAS 2 COMPONENTS : CONVERGENCE REFLEX (contraction of pupil on convergence) ACCOMODATION REFLEX (constriction of pupil on viewing a near target)
    17. 17. Convergence reflex
    18. 18. Accomodation reflex
    19. 19. PSYCHOSENSORY REFLEX Refers to the dilatation of pupil in response to sensory and psychic stimuli Complex, mechanism still not elucidated
    20. 20. • Light reflexes • Near reflex • Psychosensory reflexes OF PUPIL
    21. 21. PUPILLARY PATHWAY SHORT CILIARY NERVES N.TO INFERIOR OBLIQUE
    22. 22. Pupillary pathway
    23. 23. LESIONS IN THE PUPILLARY PATHWAY
    24. 24. OPTIC NERVE
    25. 25. 1.OPTIC NERVE • Abolition of direct reflex on affected side & consentual on opposite side amaurotic pupil
    26. 26. MEDIAL CHIASMA
    27. 27. • Medial chiasma bitemporal hemianopic paralysis
    28. 28. LATERAL CHIASMA
    29. 29. lateral chiasma binasal hemianopic paralysis
    30. 30. OPTIC TRACT
    31. 31. • OPTIC TRACT CONTRALATERAL HEMIANOPIC PARALYSIS (WERNICKE PARALYSIS) NO LIGHT REFLEX WHEN LIGHT IS THROWN ON TEMPORAL HALF OF RETINA OF AFFECTED SIDE & NASAL HALF OF OPPOSITE SIDE
    32. 32. PROXIMAL PART OF OPTIC TRACT
    33. 33. • LESION OF PROXIMAL PART OF OPTIC TRACT – NORMAL PUPILLARY REACTIONS
    34. 34. IN THE REGION OF BRACHIUM & TECTUM CONTRALATERAL HEMIANOPIC PARALYSIS
    35. 35. CENTRAL DECUSSATION
    36. 36. • BILATERAL REFLEX PARALYSIS • INACTIVITY TO LIGHT REFLEX WITH RETENTION OF NEAR REFLEX !! ARGYLL ROBERTSON PUPIL
    37. 37. ARGYLL ROBERTSON PUPIL • Pupil slightly smaller in size • Near reflex present but Light reflex absent i.e there is light near dissociation • Both pupils are involved ,dilate poorly with mydraiatics • Hallmark of tertiary syphilis (neurosyphilis)
    38. 38. B/W DECUSSATION & CONSTRICTOR CENTRE – UNILATERAL ARP
    39. 39. PARTIAL LESION
    40. 40. • Ipsilateral abolition of direct reflex,with retention of indirect • Retention of both contralaterally
    41. 41. NUCLEAR /EXTENSIVE SUPRANUCLEAR LESION Ipsilateral absolute pupillary paralysis
    42. 42. 3RD NERVE Ipsilateral absolute pupillary paralysis
    43. 43. CILIARY GANGLION
    44. 44. Lesion at ciliary ganglion • Light reflex absent,retention of near reflex (very slow) and tonic ADIE’S TONIC PUPIL
    45. 45. Adie’s pupil Affected pupil is larger Usually unilateral a/w absent knee jerk ( HOLMES ADIE SYN) young women
    46. 46. • adies’s pupil constricts with weak pilocarpine (.125 %) while normal pupil does not denervated iris sphincter is supersensitive to topical parasympathomimetics
    47. 47. OTHER CONDITIONS AFFECTING PUPILS….
    48. 48. Ophthalmoplegia interna • d/t lesion in 3rd nerve nucleus • paralysis of both sphincter pupillae & ciliary ms • Dilated,immobile pupils • Meningitis,encephalitis,cerebral syphilis, trauma affecting 3rd nerve and ciliary ganglion etc
    49. 49. Unilateral dilatation may result from irritation of cervical symapthetic nerves(swollen lymph nodes,cervical rib,apical pneumonia,meningitis affecting lower cervical &upper thoracic ventral roots..) IRRITATIVE DILATATION EVENTUALLY LEAD TO CONSTRICTION FROM SYMPATHETIC PARALYSIS
    50. 50. • • • • When all sympathetic function on one side is lost,it result in miosis, slight enophthalmos horner syndrome ptosis anhydrosis on affected side
    51. 51. HORNER’S
    52. 52. THANK YOU THANK YOU

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