pupil. The pupil is an opening located in the center of the iris that allows light to enter the retina. Its function is to control the amount of light entering the eye and it does this via contraction (miosis) and dilation (mydriasis) under the influence of the autonomic nervous system.
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(at level of Superior colliculus)
pupillae (via short ciliary nerves)
Ciliospinal centre of Budge (C8-T2)
(Uncrossed in Brainstem)
Superior Cervical Ganaglion
dilator pupillae muscle. (Close to
ICA and joins V1 intracranially)
You can then observe the pupils closely by shining a bright light on the patient's face from below (minimise the shadow cast by the nose by placing the light in the midline). If you think there is size asymmetry, a good trick is to stand back and observe the red reflex of both eyes simultaneously with the ophthalmoscope. A slight difference will then become more apparent.
1. Number-normally there is one pupil. More than one pupil is called polycoria.
2. Location- normally almost central, slightly nasal. Eccentric pupil is called correctopia.
3. Size of pupils
may be variable sizes but should be equal
– react to light
– dilated or constricted
– not reacting to light
– irregular (eg tear drop)
– not central
a) convergence reflex i.e. contraction of pupil on convergence
b) accommodation reflex i.e. contraction on accommodation
aneurysms, Neck lesions/trauma.
tumours, Otitis media, Cavernous
sinus mass and ICA disease.
this describes a unilateral (80% of cases) mydriaticpupil in otherwise healthy patients (typically young adults, especially women). Over months to years, the pupil diminishes in size to eventually become miotic. There is a sluggish, sectoral or no reaction to light but a normal near reflex. Redilation after the near-response is slow. Slit-lamp examination may reveal slow, vermiform contractions of the iris but ultimately
Does not react to light
Reacts to accommodation
Miotonic pupil (Adie’s syndrome)
Poor response to light and convergence.
Constricts with weak Pilocarpine
Reduced tendon reflexes (Knee, ankle)
- Orthostatic hypotensioncomparison