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Neuro-Ophthalmology Division Department of Ophthalmology and Visual Science

The Irregular Pupil. Randy Kardon M.D. Ph.D. Neuro-Ophthalmology Division Department of Ophthalmology and Visual Science VA and University Hospital, Iowa City, Iowa. Causes of an Irregular Pupil. the iris tissue itself – muscle and stroma

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Neuro-Ophthalmology Division Department of Ophthalmology and Visual Science

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  1. The Irregular Pupil Randy Kardon M.D. Ph.D. Neuro-Ophthalmology Division Department of Ophthalmology and Visual Science VA and University Hospital, Iowa City, Iowa

  2. Causes of an Irregular Pupil • the iris tissue itself – muscle and stroma • nerve causes – segmental denervation or aberrant re-innervation of either parasympathetic or sympathetic nerves • central nervous system (rare) – midbrain “corectopia” and brainstem herniation

  3. Iris Causes of an Irregular Pupil The iris tissue itself – muscle and stroma ICE Rieger’s ICE Axonfeld’s/Rieger’s Sphincter tears Ischemia Zoster Post surgical Coloboma Iris Synechia Ectropian Uveae Iris Tumor/Cyst

  4. Nerve Causes of an Irregular Pupil postganglionic sympathetic denervation of the iris dilator light dark 3 seconds dark 8 seconds

  5. Nerve Causes of an Irregular Pupil postganglionic sympathetic denervation of the iris dilator and aberrant re-innervation of some dilator sectors light dark 5 seconds in dark, “swallowing”

  6. Nerve Causes of an Irregular Pupil postganglionic sympathetic denervation of the iris dilator and aberrant re-innervation of some dilator sectors light video in dark, swallowing cold water dark 5 seconds

  7. Nerve Causes of an Irregular Pupil segmental sympathetic pulling on the dilator “tadpole pupil”

  8. Nerve Causes of an Irregular Pupil segmental sympathetic pulling on the dilator tadpole pupil video

  9. Nerve Causes of an Irregular Pupil abnormal parasympathetic innervation to the sphincter Dark Chronic “Little Old Adie’s Pupil” Bright Light Near

  10. Infrared front illumination Infrared transillumination Dark Near 0.5% tropicamide

  11. CNS Causes of an Irregular Pupil rare The oval pupil: relationship to intracranial hypertension Marshall et al, J Neurosurgery 58:566-568. 1983 Midbrain “Corectopia” Selhorst et al, Arch Neurol 33,193, 1976 brainstem herniation

  12. Causes of an Irregular Pupil • the iris tissue itself – muscle and stroma • nerve causes – segmental denervation or aberrant re-innervation of either parasympathetic or sympathetic nerves • central nervous system (rare) – midbrain “corectopia” and brainstem herniation

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