Note this patient has an abnormal iris as well likely secondary to surgical trauma. These are the densest cataracts.
Horners Syndrome Ptosis, miosis, anhidrosis The abnormal pupil in this syndrome is the smaller, left pupil. Note also the left lid droop ptosis. Cranial Nerve 3 Palsy Note the right pupil is enlarged and the right eye is deviated outwards and downwards. These are pupils that do not constrict to light but will bilaterally accomodate with the near response. Tip 2: Fixation Ask the patient to maintain fixation on a distant target.
Tip 3: Room Lighting Examination of pupil should be done in a room with dim illumination in order to avoid constriction caused by a brightly lit room. Tip 4: Illumination Use an evenly bright source of illumination for examining the light reflexes. Tip 5: Dark Irises It is often difficult to view a consensual pupillary response in patients with dark irises in dark rooms. Examining Pupil Reflexes 1 Direct reflex Method: While the patient looks at a distant target, shine the light from inferiorly and slightly temporal shining the light from directly in front of the eye will stimulate the near reflex that will produce pupil constriction Normal response: contraction of pupils capture by sphincter pupillae Record the speed of reaction: brisk, sluggish, or fixed 2 Consensual reflex Method: While the patient is looking at a distant target, shine the light on one pupil and notice the reaction in the other eye.
Normal response: contraction of the contralateral pupil when light shone in one eye which should be approximately equal in velocity and extent to the direct pupillary response. Record the speed of reaction: brisk, sluggish, or fixed 3 Near reflex Method: Ask patient to focus on a distant object in a moderately lit room.
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A positive RAPD is noted when the pupil dilates when you move the light from one side to the other. Sometimes, the pupil will bounce a little when you swing the flashlight over.
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However, if you keep the light shining on the pupil, it will return to the normal constricted size. Journal logo. The Pupil Marc A.
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