Neuroophthalmology, part 2 pupils david'kinshuckgoodhope'nhs'uk

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Neuro-ophthalmology, part 2 pupilsdavid.kinshuck
_at_goodhope.nhs.uk

• Common pupil abnormalities
• Show the problems, explain the anatomy briefly,
  ..so you may remember
• Present, a few questions as we go, then a
  mini-break for a tiny quiz

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1st animation
Watch I will describe what is happening You
describe Where is the problem, and why?
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1st animation
Watch I will describe what is happening You
describe Where is the problem, and why?
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Healthy

• Light reflex pathway

www.ophthalmic.hyperguides.com/.../ slide1.asp
www.ophthalmic.hyperguides.com/.../ slide1.asp
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Right optic nerve disease
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Right optic nerve disease

• Animation..left

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Right optic nerve disease

• right

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2nd animation
Watch I will describe what is happening You
describe Where is the problem, and why?
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Right adies
Pupils do respond to accomodation (slowly)
www.ophthalmic.hyperguides.com/.../ slide1.asp
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3rd pupil problem
Watch Describe the signs Where is the problem,
and why?
www.mrcophth.com
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Another case
Watch Describe the signs Where is the problem,
and why?
www.ophthalmic.hyperguides.com/.../ slide1.asp
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Horners

• pathway

www.ophthalmic.hyperguides.com/.../ slide1.asp
www.ophthalmic.hyperguides.com
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4th type of problem
What is going on here?
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3rd Nerve palsy
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3rd Nerve palsyyoung person
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Other pupil problemseye disease
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Pupils mini-quiz

• RgtL left pupil
• Possible diagnosis (1) (2) (3)
• Describe 3 eye signs that may clarify diagnosis

Diagnosis 3. Young patient..? 4. Old patient?
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Questions
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Summary

• APDafferent defect (eg optic nerve)light in
  good eye, both pupils respond
• Adies(efferent)one pupil does not respond
  wherever light shone (but other pupil responds to
  light in both eyes)
• Some serious causes..part of a third
  nerve..aneursym horners
• Diagnostic dilemmas
• Exam cases