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51 The Normal Pupillary Light ReflexThe normal pupillary light reflex is initiated following exposure to light. After a brief latency, both the right (solid line) and left (broken line) pupil constrict, then undergo a small amount of redilation (escape), followed by oscillations (hippus) if the light is sustained. Hippus is not a path...Image
52 Notching of the Neuro-retinal RimThe neuro-retinal rim becomes thinner; in particular the rim superotemporally and inferortemporally may develop a notch which is usually superior or inferior and rarely nasal or temporal. These notches are believed to be due to focal ischemic damage to the neuro-retinal rim. Glaucoma with Notching a...Image
53 Pathophysiology of Signs Associated with a Tonic PupilPathophysiology of signs associated with a tonic pupil. Normally, all parasympathetic fibers of the third cranial nerve synapse in the ciliary ganglion (top). Most postganglionic fibers innervate the ciliary muscle (dashed lines). After injury to the ciliary ganglion, the pupil becomes denervated an...Image
54 Pupil Signs in a 32-year-old Woman with Right-sided Adie's PupilPupil signs in a 32-year-old woman with right-sided Adie's pupil. The right pupil is larger than the left pupil (top), reacts poorly to direct light stimulation (second panel), and better in response to near stimulation (third panel). The right pupil also shows a supersensitive response 30 minutes a...Image
55 Pupillogram Demonstrating Paradoxical Pupillary Constriction to DarknessPupillogram demonstrating paradoxical pupillary constriction to darkness in four patients with congenital achromatopsia. Note that the pupils initially constrict when the light is extinguished. (Price MJ, Thompson HS, Judisch GF et al: Pupillary constriction to darkness. Br J Ophthalmol 1981;69:205-...Image
56 Pupillogram of a Healthy Young SubjectPupillogram of a healthy young subject showing continuous pupillary oscillations of both pupils when light is sustained, indicated by the dark arrow at the top of the recording. Note that the oscillations of the pupils are synchronous and demonstrate variable amplitude and frequency. This pattern of...Image
57 Relationship Between Age and Pupil SizeRelationship between age and pupil size, determined using an infrared flash photograph technique with subjects placed in darkness for 3 minutes. The numbers above the abscissa indicate the number of subjects tested in each age range. (Reprinted with permission of Loewenfeld IE: "Simple, central" ani...Image
58 Right-sided Pseudo-Horner's SyndromeRight-sided pseudo-Horner's syndrome in an 8-month-old infant referred because her mother had noted a larger pupil on the left for a few months and her pediatrician thought the right upper lid was droopy. Both pupils reacted normally to light and darkness, the degree of anisocoria was similar in bot...Image
59 Right-sided Relative Afferent Pupillary DefectRight-sided relative afferent pupillary defect in a man with optic nerve glioma. When the unaffected left eye is stimulated by light, both pupils constrict (top). When the light is then swung over to the affected right eye, both pupils dilate (bottom). This indicates that pupillomotor conduction thr...Image
60 See-saw Nystagmus MRI 1MRI; See-saw NystagmusImage
61 See-saw Nystagmus MRI 2MRI; See-saw NystagmusImage
62 Shunt Vessel MeningiomaRETINO-CHOROIDAL (OPTO-CILIARY) COLLATERAL VESSELS: (also known as Retinal-choroidal venous collaterals, opticociliary veins or ciliary shunt vessels) Retino-choroidal collaterals are potential telangiectatic connections between the retina and choroidal circulation. Although sometimes called "shunts...Image
63 Shunt Vessel Meningioma - MRIMeningiomas block venous egress and open potential venous channels known as retinochoroidal (optociliary) collateral vein. This meningioma extends from the back of the globe through the optic canal.Image
64 Stage 2 - PapilledemaImage
65 Structures of the irisStructures of the iris. The a indicates the anterior border layer that terminates at the pigmentary ruff of the pupillary border (b). The c indicates the iris sphincter muscle, which is oriented circumferentially within the stroma and located deep to the anterior border layer; d indicates vessels th...Image
66 Tadpole-shaped PupilTadpole-shaped pupil in a 20-year-old women with frequent episodes of blurred vision and achiness of the right eye lasting several minutes. The patient took a photograph of her eyes during an attack to document the peaked, segmental dilation of her right pupil (black arow). (Thompson HS, Zackon DH, ...Image
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