Clinical Management Guidelines: Abnormalities of the Pupil PDF

05/11/2024, 21:05 Abnormalities of the pupil - College of Optometrists We use cookies to give you a better online experience....

05/11/2024, 21:05 Abnormalities of the pupil - College of Optometrists We use cookies to give you a better online experience. ACCEPT REJECT By using our website you consent to all cookies in accordance with our Privacy Policy    Clinical Management Guidelines The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care. HOW TO USE CMGS   In this section... Abnormalities of the pupil Contents Aetiology Predisposing factors Symptoms of pupil abnormalities Signs of pupil abnormalities Differential diagnosis Management by optometrist Management category Possible management in secondary care or local primary/community pathways where available Evidence base Information for patients Aetiology Although pupil anomalies are commonly benign, they may be the first or only manifestation of a serious or even life-threatening disorder. Physiological (‘simple’) anisocoria Unequal pupil sizes in the absence of an underlying pathological cause Idiopathic, stable and longstanding Depending on the level of illumination, found in up to 20% of individuals Increased prevalence with age Tonic (Adie’s) pupil Caused by parasympathetic denervation at the level of the ciliary ganglion Most commonly seen in women (2.6:1) aged 20-40 years Prevalence 2 per 1,000 of the general population Usually idiopathic but case reports of associations with viral infections (e.g. varicella zoster) and a number of connective tissue diseases (e.g. Sjögren’s disease and rheumatoid arthritis). May also be seen in patients with generalised peripheral or autonomic neuropathies When associated with absent or poor tendon reflexes known as Holmes-Adie syndrome Horner’s syndrome Congenital or acquired https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/abnormalitiesofthepupil 1/5 05/11/2024, 21:05 Abnormalities of the pupil - College of Optometrists Rare in adults, birth prevalence of 1 in 6250 for those with a congenital onset Caused by interruption of the oculosympathetic innervation at any point along the neural pathway from the hypothalamus to the orbit Usually benign or occurs after surgery, but could also indicate a carotid dissection or neoplasia Argyll Robertson pupil Associated with neurosyphilis Thought to result from a lesion in the midbrain that disables the pathway for the pupillary light reflex but does not affect the more ventral pathway mediating the near reaction Predisposing factors Tonic pupil Female gender Horner’s syndrome In children, birth trauma is the most common cause of Horner’s syndrome. Argyll Robertson pupil Observed in the tertiary and final stage of infection with syphilis. Symptoms of pupil abnormalities Generally asymptomatic, although pupil abnormalities may be associated with pain, photophobia or visual disturbance Ipsilateral orbital, face, or neck pain has been reported in up to 58% of cases of Horner’s syndrome associated with internal carotid artery dissection Signs of pupil abnormalities Physiological (‘simple’) anisocoria Anisocoria ≥0.5mm but typically