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Pupil Anomalies and Anisocoria
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Pupil Anomalies and Anisocoria

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Questions and Answers

What percentage of individuals may exhibit physiological anisocoria?

  • 20% (correct)
  • 30%
  • 40%
  • 10%

    • What is the most common cause of Horner's syndrome in children?

  • Viral infections
  • Carotid dissection
  • Neoplasia
  • Birth trauma (correct)

    • Which of the following is a predisposing factor for tonic pupil?

  • Male gender
  • Autonomic neuropathy
  • Age above 60 years
  • Female gender (correct)

    • What is the estimated prevalence of tonic pupil in the general population?

    <p>2 per 1000</p> Signup and view all the answers

    Which of the following is a characteristic feature of Argyll Robertson pupil?

    <p>Reaction to light is impaired but near vision is preserved</p> Signup and view all the answers

    What is the estimated birth prevalence of Horner's syndrome?

    <p>1 in 6250</p> Signup and view all the answers

    What is the age range in which tonic pupil commonly occurs?

    <p>20-40 years</p> Signup and view all the answers

    What is the underlying pathology in Horner's syndrome?

    <p>Interruption of the oculosympathetic innervation</p> Signup and view all the answers

    What condition is associated with Argyll Robertson pupil?

    <p>Neurosyphilis</p> Signup and view all the answers

    What is the characteristic feature of physiological anisocoria?

    <p>Unequal pupil sizes without an underlying pathological cause</p> Signup and view all the answers

    What is the primary cause of the interruption of the oculosympathetic innervation in Horner's syndrome?

    <p>Neoplasia or carotid dissection</p> Signup and view all the answers

    What is the characteristic commonality between tonic pupil and Horner's syndrome?

    <p>Both can be idiopathic or associated with other conditions</p> Signup and view all the answers

    What is the estimated proportion of individuals who may exhibit unequal pupil sizes in the absence of an underlying pathological cause?

    <p>Up to 20%</p> Signup and view all the answers

    What is the age range in which Horner's syndrome is more commonly seen in?

    <p>Children and adults</p> Signup and view all the answers

    What is the association between Argyll Robertson pupil and neurosyphilis?

    <p>Argyll Robertson pupil is associated with neurosyphilis</p> Signup and view all the answers

    What is the characteristic feature of the near reaction in Argyll Robertson pupil?

    <p>Affecting the ventral pathway mediating the near reaction</p> Signup and view all the answers

    What is the primary difference between tonic pupil and Horner's syndrome?

    <p>Tonic pupil is caused by parasympathetic denervation, while Horner's syndrome is caused by interruption of the oculosympathetic innervation</p> Signup and view all the answers

    What is the characteristic feature of idiopathic anisocoria?

    <p>Unequal pupil sizes in the absence of an underlying pathological cause</p> Signup and view all the answers

    What is the common association between tonic pupil and other conditions?

    <p>Sjögren's disease and rheumatoid arthritis</p> Signup and view all the answers

    What is the characteristic feature of the Holmes-Adie syndrome?

    <p>Absent or poor tendon reflexes</p> Signup and view all the answers

    Which of the following conditions is typically associated with a benign course?

    <p>Physiological anisocoria</p> Signup and view all the answers

    What is the primary mechanism underlying tonic pupil?

    <p>Parasympathetic denervation at the level of the ciliary ganglion</p> Signup and view all the answers

    Which of the following is a predisposing factor for both tonic pupil and Horner's syndrome?

    <p>Female gender</p> Signup and view all the answers

    What is the characteristic feature of the pupillary light reflex in Argyll Robertson pupil?

    <p>It is absent</p> Signup and view all the answers

    Which of the following conditions is associated with a higher prevalence in women?

    <p>Tonic pupil</p> Signup and view all the answers

    What is the characteristic feature of the near reaction in physiological anisocoria?

    <p>It is preserved</p> Signup and view all the answers

    Which of the following conditions is associated with a higher risk of carotid dissection or neoplasia?

    <p>Horner's syndrome</p> Signup and view all the answers

    What is the primary difference between tonic pupil and Horner's syndrome?

    <p>The underlying pathology</p> Signup and view all the answers

    Which of the following conditions is typically seen in association with generalised peripheral or autonomic neuropathies?

    <p>Tonic pupil</p> Signup and view all the answers

    What is the characteristic feature of the pupillary light reflex in physiological anisocoria?

    <p>It is preserved</p> Signup and view all the answers

    What is the term for unequal pupil sizes in the absence of an underlying pathological cause?

    <p>Physiological anisocoria</p> Signup and view all the answers

    What is the estimated prevalence of tonic pupil in the general population of women?

    <p>2.6 per 1000</p> Signup and view all the answers

    What is the characteristic feature of the pupillary light reflex in tonic pupil?

    <p>Intact pathway for the pupillary light reflex</p> Signup and view all the answers

    What is the most common association with Horner's syndrome in children?

    <p>Birth trauma</p> Signup and view all the answers

    What is the characteristic feature of Argyll Robertson pupil in terms of the near reaction?

    <p>Intact pathway for the near reaction</p> Signup and view all the answers

    What is the underlying pathology of Horner's syndrome?

    <p>Interruption of the oculosympathetic innervation</p> Signup and view all the answers

    What is the estimated prevalence of physiological anisocoria in the general population?

    <p>Up to 20%</p> Signup and view all the answers

    What is the characteristic feature of tonic pupil in terms of the pupillary light reflex?

    <p>Intact pathway for the pupillary light reflex</p> Signup and view all the answers

    What is the association between Horner's syndrome and carotid dissection or neoplasia?

    <p>Common association</p> Signup and view all the answers

    What is the characteristic feature of idiopathic anisocoria?

    <p>Unequal pupil sizes in the absence of an underlying pathological cause</p> Signup and view all the answers

    Study Notes

    • Pupil anomalies can be benign, but may also be the first or only manifestation of a serious or even life-threatening disorder.

    • Physiological (‘simple’) anisocoria is a condition where pupil sizes are unequal in the absence of an underlying pathological cause, and is found in up to 20% of individuals, with increased prevalence with age.

    • Tonic (Adie’s) pupil is caused by parasympathetic denervation at the level of the ciliary ganglion, and is most commonly seen in women (2.6:1) aged 20-40 years, with a prevalence of 2 per 1,000 of the general population.

    • Tonic pupil is usually idiopathic, but can be associated with viral infections, connective tissue diseases, and generalised peripheral or autonomic neuropathies.

    • Horner’s syndrome is caused by interruption of the oculosympathetic innervation at any point along the neural pathway from the hypothalamus to the orbit, and is rare in adults, with a birth prevalence of 1 in 6250 for those with a congenital onset.

    • Horner’s syndrome can be benign or occur after surgery, but can also indicate a carotid dissection or neoplasia.

    • Argyll Robertson pupil is associated with neurosyphilis, and is thought to result from a lesion in the midbrain that disables the pathway for the pupillary light reflex.

    • Female gender is a predisposing factor for tonic pupil, and birth trauma is the most common cause of Horner’s syndrome in children.

    • Holmes-Adie syndrome is a condition where tonic pupil is associated with absent or poor tendon reflexes.

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    Description

    Test your knowledge of pupil anomalies, including benign and serious causes, as well as idiopathic and tonic pupil conditions. Learn about the prevalence and characteristics of these conditions.

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