Neurophthalmology

Question 1

anisocoria

Answer 1

a difference in size between pupils

Question 2

Neurophthalmology exam

Answer 2

1. look for anisocoria
2. check normal reaction to light and dark
3. observe pupils in light and dark
4. observe papillary response to light
5. observe for segmental palsy
6. observe for light-near dissociation
7. observe for tonic dilation

Question 3

light-near dissociation

Answer 3

better constriction when viewing a near object than to light stimulation

Question 4

segmental palsy

Answer 4

unequal constriction of the pupil

Question 5

Sympathetic pupillary disturbances:

Answer 5

1. Sympathetic innervation normally results in papillary dilation.
2. If sympathetic pathways are damaged the abnormal pupil will be miotic and will have an abnormal dark reaction, meaning it will not fully dilate.
3. This makes the anisocoria worse in the dark.

Question 6

ParaSympathetic pupillary disturbances:

Answer 6

1. Parasympathetic innervation causes papillary constriction, so damage will result in a pupil that is mydriatic and poorly responsive to light.
2. The anisocoria thus appears worse in the light.

Question 7

Horner’s Syndrome: symp or para

Answer 7

sympathetic problem

Question 8

Horner’s Syndrome: anisocoria

Answer 8

miosis

Question 9

Horner’s Syndrome: light reaction

Answer 9

abnormal dark reaction

Question 10

Horner’s Syndrome: other signs

Answer 10

Also accompanied by Ptosis and anhidrosis (usually unilaterally)

Question 11

Iris Damage: symp or para

Answer 11

Parasympathetic Problem

Question 12

iris damage: anisocoria

Answer 12

myadriasis

Question 13

iris damage: light reaction

Answer 13

abnormal light reaction

Question 14

iris damage: other signs

Answer 14

non-neurologic cause

Question 15

3rd Nerve Palsy: symp or para

Answer 15

parasympathetic problems

Question 16

3rd Nerve Palsy: anisocoria

Answer 16

mydriasis

Question 17

3rd Nerve Palsy: light reaction

Answer 17

abnormal light reaction

Question 18

3rd Nerve Palsy: other signs

Answer 18

Accompanied by other signs of 3rd nerve damage including ptosis and EOM paresis

Question 19

Tonic Pupil: symp or para

Answer 19

parasympathetic problem

Question 20

Tonic Pupil: anisocoria

Answer 20

myadriasis

Question 21

Tonic Pupil: light reaction

Answer 21

abnormal light reaction

Question 22

Tonic Pupil: other signs

Answer 22

1. Light-near dissociation
   (due to regrowth of nerve fibers, more of which are dedicated to accommodation) and
2. segmental constriction