Abnormal Pupillary Responses

Abnormal Pupillary Reactions

Anisocoria: – ( unequal pupils) is present in about 20% of the normal population

Pathological Anisocoria
- Large pupil – 3rd nerve paresis – associated with 3rd neve paresis -fails to constrict with light
- Small pupil – sympathetic paralysis (Horner’s Syndrome)
- Mydriasis may also occur because of eye drops, some plants and trauma.
- Horner’s Syndrome – Miosis, Ptosis, Enophthalmos, anhydrosis
If this occurs before two years of age Heterochromia of the Iris results.
Congenital Horner’s commonly occurs due to birth trauma but occasionally may be due to a mediastinal tumour (eg neuroblastoma.)

Afferent Pupillary Defect -Marcus Gunn Pupil, Swinging light test.                        
If Reaction to direct light< consensual reaction.   = Optic nerve dysfunction          video