NOVEL - Moran Eye Center
 
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101 Anatomy of the Pupillary Light Reflex PathwayAnatomy of the pupillary light reflex pathway. (Miller NR: Walsh And Hoyt's Clinical Neuro-Ophthalmology, p 421. Vol 2, 4th ed. Baltimore: Williams & Wilkins, 1985, with permission.)Image
102 Location of Pupillomotor FibersLocation of pupillomotor fibers are depicted as dark regions on cross-sections of the right (R) and left (L) oculomotor nerve at various locations along its course, including its emergence from the brain stem in the interpeduncular fossa (1), the midsubarachnoid segment (2), the level of the dorsum ...Image
103 Anatomy of the Oculosympathetic PathwayAnatomy of the oculosympathetic pathway. (Maloney WF, Younge BR, Moyer NJ: Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. Am J Ophthalmol 1980;90:394-402, Ophthalmic Publishing Company with permission.)Image
104 The Course of the Postganglionic Segment of the Oculosympathetic Fibers from the Internal Carotid ArteryThe course of the postganglionic segment of the oculosympathetic fibers from the internal carotid artery (ICA) to the orbit is depicted as a dotted line. Note that they briefly join the abducens nerve (cranial nerve VI) before joining the nasociliary branch of the of the ophthalmic division of the t...Image
105 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
106 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
107 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
108 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
109 Assessment of an Afferent Pupillary Defect When Only One Iris is FunctionalAssessment of an afferent pupillary defect when only one iris is functional. In this example, a right-sided parasellar tumor is compressing both the optic and oculomotor nerves, causing an optic neuropathy and a pupil-involving third crainial nerve palsy. The pupil on the affected side has both an a...Image
110 Hand-held Equipment Used to Measure a Relative Afferent Pupillary DefectHand-held equipment used to measure a relative afferent pupillary defect and to record pupil sizes. Four neutral density filters (0.3, 0.6, 0.9, 1.2 log units) are conveniently carried in a soft cloth carrying pouch. A bright light source (a Finhoff model illuminator is shown here) is ideal for stim...Image
111 An Enhancing Bladder Metastasis Involving the Tectum of the MidbrainMagnetic resonance image of an enhancing bladder metastasis involving the tectum of the midbrain of a 56-year-old man who developed double vision resulting from skew deviation and divergence insufficiency. He also had a left-sided relative afferent pupillary defect measuring 1.4 log units but showed...Image
112 Light-near DissociationLight-near dissociation in a 51-year-old woman with multiple sclerosis who experienced double vision for 1 week. Her pupils are 5 mm in diameter in room light (top), react poorly in response to direct light reaction (middle), but constrict promptly in response to near stimulation (bottom). She also ...Image
113 Argyll Robertson PupilsArgyll Robertson pupils in an elderly man treated for tabes dorsalis in 1952. His pupils are small and slightly irregular, constrict poorly in response to light stimulation (top), dilate poorly in darkness (middle), but constrict promptly in response to near stimulation (bottom).Image
114 Aberrant Regeneration of the Right PupilAberrant regeneration of the right pupil in a man with a large intracavernous sinus meningioma causing a pupil-involving, incomplete third cranial nerve palsy. His pupil is round when he gazes straight ahead (top). When he tries to rotate the eye medially, the pupil constricts, but a segment of the ...Image
115 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
116 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
117 Bilateral Iris Colobomas (B)Bilateral iris colobomas. B. Bilateral colobomatous defects of the inferonasal retina (black arrows) are also present, as shown in the right eye.Image
118 Left-sided Horner's Syndrome with an Acquired Preganglionic LocalizationLeft-sided Horner's syndrome in a 12-year-old girl with an acquired preganglionic localization based on clinical and pharmacologic testing. The cause remained undetermined after extensive radiologic investigations. Left-sided ptosis and miosis are evident in room light (top), and the degree of aniso...Image
119 Left-sided Dilation Lag in a Man with Horner's SyndromeLeft-sided dilation lag in a 29-year-old man with Horner's syndrome caused by a posterior mediastinal ganglioneuroma. Note that the degree of anisocoria is greater after 5 seconds in darkness (top) compared with findings after 15 seconds in darkness (bottom).Image
120 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
121 Enhanced Mydriasis in Response to HydroxyamphetamineEnhanced mydriasis in response to hydroxyamphetamine in a 77-year-old woman with a long-standing, preganglionic, right-sided Horner's syndrome that occurred following cervical neck dissection for thoracic outlet syndrome 30 years earlier. Miosis of the right pupil is apparent in room light (top). Th...Image
122 Left-sided Internal Carotid Artery DissectionLeft-sided internal carotid artery dissection identified on T-1 weighted magnetic resonance image from a 52-year-old man who suddenly developed left-sided neck and orbital pain along with a droopy left upper eyelid while dragging a deer out of the woods during hunting season. The normal dark flow vo...Image
123 Flow Chart for Sorting Out Anisocoria - Direct Light Reaction of the PupilFlow chart for sorting out anisocoria based initially on the integrity of the direct light reaction of the pupil.Image
124 Flow Chart for Sorting Out Anisocoria - Bright Light and DarknessFlow chart for sorting out anisocoria based initially on how it is influenced by bright light and darkness.Image
125 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
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