Ординатура / Офтальмология / Английские материалы / Ocular Differential Diagnosis 7th edition_Roy_2002

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3. Toxins, including after-shave lotion, arsenic, Clostridium botulinum (gas gangrene), tetanus (lockjaw), cannabis, adrenergic agents (such as nasal sprays or asthma therapy in newborns), paraaminosalicylic acid, lead, carbon monoxide, organic phosphorus, bovine milk protein in infants with allergic malabsorption, Datura stramonium (Jimson weed), Datura wrightii (moonflower), and Solanaceae (nightshade), nitrocompounds and aminocompounds of benzene, carbon disulfide, and papaverine.

4. Ocular causes (mydriasis) (see fixed pupil section p. 348)

A.Glaucoma, usually acute

B.Glaucomocylitic crisis (Posnerâ??Schlossman syndrome)

C.Hollenhorst syndrome (chorioretinal infarction syndrome)

D.*Iritis; uveitis

E.Intraocular foreign body (iron mydriasis)

F.Iris atrophy

G.Iris sphincter rupture

H.*Paralytic mydriasis following trauma

I.Photocoagulation complications

J.Retinoblastoma

5. Lesions of ciliary ganglion causing internal ophthalmoplegia (e.g., dilated pupil and absent accommodation)

A.Adie tonic pupil

B.Congenital lesion

C.Herpes zoster

D.Orbital floor fracture repair

E.Systemic lupus erythematosus (disseminated lupus erythematosus)

F.Varicella (chickenpox)

G.Yellow fever

6. Acute or chronic ophthalmoplegias (see p. 168â??171)

7. Third-nerve lesionâ??also ptosis and ophthalmoplegia on affected side (see p. 168â??171) 8. Coma because of alcohol ingestion, eclampsia, diabetes, uremia, epilepsy, apoplexy, or

meningitisâ??the pupils are equally dilated and do not constrict with stimulation

9. Midbrain tumors, in which dilated pupils, paralysis of vertical gaze (especially upward gaze), and retraction nystagmus are manifested

A.Craniopharyngioma

B.Parinaud syndrome (paralysis of upgaze movements)

10. Epidural or subdural hematoma

11. Paralytic parasympathetic lesions

12. Irritative sympathetic lesionâ??pupillary dilatation widening of palpebral aperture and slight exophthalmos

A.Irritative lesion, such as tumor, encephalitis, or syringomyelia of the hypothalamus, midbrain, medulla, or cervical cord

B.Thoracic lesions, such as cervical rib, aneurysms of the thoracic vessels, mediastinal tumors, or tubercular pleurisy

C.*Cervical lesions, including nasopharyngeal tumors, thyroid swelling, or cervical nodes

D.Rabies (hydrophobia)

E.*Trauma

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F.Visceral disease

G.Aortic dilatation or exudative endocarditis (Roque sign)

H.Acute abdominal conditions, such as appendicitis, cholecystitis, or colitis (Moschowitz sign)

I.Psychiatric patients with pressure over McBurney point (Meyer phenomenon)

13. Tumors, injury, or hemorrhage of frontoparietal, parietal, temporal, or temporooccipital areaâ??contralateral mydriasis and ipsilateral defect in the visual field

14. Fractured skull

15. Acute autonomic neuropathy

16. Acute pandysautonomia

17. Avitaminosis Bz (pellagra)

18. Chorea

19. Clivus edge syndrome

20. Craniocervical syndrome (whiplash injury)

21. Foramen lacerum syndrome (aneurysm of internal carotid artery syndrome) 22. Hemiacrosomia syndrome (hemifacial or unilateral hypertrophy)

23. Iron deficiency anemia

24. Lockjaw (tetanus)

25. Mycosis fungoides syndrome (Sézary syndrome)

26. Optic canal syndrome

27. Parkinson syndrome (shaking palsy)

28. Prematurity

29. Pulseless disease

30. Reye syndrome (acute encephalopathy syndrome)

31. Rollet syndrome (orbital apexâ??sphenoidal syndrome)

32. Suprarenalâ??sympathetic syndrome (adrenal medulla tumor syndrome)

33. Temporal arteritis

34. Weber syndrome (cerebellar peduncle syndrome)

35. Wernicke syndrome (I) (avitaminosis B1 thiamine deficiency) 36. Zellweger syndrome (cerebrohepatorenal syndrome)

Bodker FS, et al. Postoperative mydriasis after repair of orbital floor fracture. Am J Ophthalmol,1993;115:372â??375.

Cuppeto JR, Greco T. Mydriasis in giant cell arteritis. J Clin Neuroophthalmol 1985;9:267.Bibliographic Links

Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA Butterworth-Heinemann, 2001.

Hendrix LE, et al. Papaverine-induced mydriasis. AJNR Am J Neuroradiol 1994;15:716â??718.Bibliographic Links

Isenberg SJ, et al. The fixed and dilated pupils of premature neonates. Am J Ophthalmol 1990;110:168.Bibliographic Links

Pau H. Differential diagnosis of eye diseases, 2nd ed. New York: Thieme Medical, 1988.

Richardson P, Schulenburg WE. Bilateral congenital mydriasis. Br J Ophthalmol 1992;76:632â??633.Bibliographic Links

Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Relative Fixed, Dilated Pupil

1. Midbrain damageâ??vascular accidents, tumors, degenerative and infectious diseases

A.Dorsal (Edingerâ??Westphal nucleus and its connections)â??rare, involves both pupils, pupillary near reaction often retained, and often associated with supranuclear vertical gaze palsy (upgaze)

B.*Ventral (fascicular part of third nerve)â??associated with other neurologic deficits, such as Nothnagel syndrome, Benedikt syndrome, Weber syndrome, and involves other extraocular components of the third nerve

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2. *Damage to the third nerve (from interpeduncular fossa to ciliary ganglion)

A.Basal aneurysms

B.Supratentorial space-occupying masses, causing displacement of the brainstem or transtentorial herniation of the uncus; patient is stuporous or comatose

C.Basal meningitisâ??often bilateral internal ophthalmoplegia

D.*Ischemic oculomotor palsy

1971;86:21â??27.Bibliographic Links

Miosis (Small Pupil) (Usually <2 MM)

1. Physiologic

A.Smaller pupil in men than in women

B.Smaller pupil in hypermetropes than in myopes

C.Smaller pupil in brown irides than in blue irides

D.Smaller pupil in very young or old than in adolescents and middle-aged persons

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E.Sleep, fatigue, coma

F.Stage III anesthesia

G.Near vision (synkinesis with convergence and accommodation)

H.Vestibular stimulation

2. Drugs, including the following:

3. Ocular causes

A.*Accommodative spasm (hysteria)

B.Corneal irritation, such as keratitis or corneal injury

C.Conjunctival irritation

D.Congenital miosis (absent dilator muscle)

E.Dislocated lenses

F.Iritis

G.*Posterior iris synechiae, usually irregular

H.Retinitis pigmentosa

4. Central nervous system defects

A.Acute pontine angle lesion, such as hemorrhage or tumor associated with disturbed conjugate gaze

B.Arteriosclerotic and degenerative disease of the cerebrum

C.Encephalitis

D.Facial tetanus

E.Giant cell (temporal arteritis)

F.Infections or tumors of the cavernous sinus or superior orbital fissure

G.Purulent meningitis

H.Severe hypoxia

5. â??Cluster headacheâ? or histamine cephalgiaâ??ptosis; miosis; red, watering eye on side of headache

6. Raeder paratrigeminal syndromeâ??ipsilateral miosis and painâ??may be associated with third-nerve paralysis or corneal anesthesia

A.Extracranial aneurysm of internal carotid

B.Idiopathic

C.Meningioma

D.Migraine

E.Posttrauma

7. Argyll Robertson pupilâ??small and irregular; reacts better to accommodation than to light

A.Aberrant regeneration of the third nerve

B.Carbon disulfide poisoning

C.Cerebral aneurysm

D.Chronic alcoholism

E.*Diabetes mellitus (Willis disease)

F.Encephalitis

G.Friedreich ataxia

H.Malaria

I.Midbrain tumors, such as pinealomas and craniopharyngioma

J.Multiple sclerosis (disseminated sclerosis)

K.Senile and degenerative diseases of the central nervous system

L.Syphilis (acquired lues)

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M.Syringomyelia

N.Trauma to skull or orbit

8. Ataxia, spastic with congenital miosisâ??dominant

9. Babinskiâ??Nageotte syndrome (medulla tegmental paralysis)

10. Coenurosis

11. Craniocervical syndrome (whiplash injury)

12. Dejerineâ??Klumpke syndrome (lower radicular syndrome)

13. Devic syndrome (neuromyelitis optica)

14. *Diabetes mellitus

15. Eatonâ??Lambert syndrome (myasthenic syndrome)

16. Elevated intracranial pressure

17. *Horner syndrome (cervical sympathetic paralysis syndrome)

18. Jugular foramen syndrome (Vernet syndrome)

19. Lowe syndrome (oculocerebrorenal syndrome)

20. Marfan syndrome (arachnodactyly dystrophia mesodermalis congenita)

21. Morquio syndrome (mucopolysaccharidosis IV)

22. Myotonic dystrophy (Curschmannâ??Stewart syndrome)

23. Naffziger syndrome (scalenus anticus syndrome)

24. Pancoast syndrome (superior pulmonary sulcus syndrome)

25. Parkinsonism (shaking palsy)

26. Psychogenic diseases, such as schizophrenia, dementia precox, or hysteria 27. Refsum syndrome (phytanic acid storage disease)

28. Retroparotid space syndrome (Villaret syndrome)

29. Romberg syndrome (facial hemiatrophy)

30. Spider bites

31. Stormorken syndrome (thrombocytopathia bleeding tendency)

32. Tetanus (lockjaw)

33. von Herrenschwand syndrome (sympathetic heterochromia)

34. Wallenberg syndrome (dorsolateral medullary syndrome) 35. Wernicke syndrome (avitaminosis B1, thiamine deficiency)

Fraunfelder FT, Fraunfelder FW. Drug-induced ocular side effects. Woburn, MA: Butterworth-Heinemann, 2001.

Ghanchi F, Dutton GN. Current concepts in giant cell (temporal) arteritis. Surv Ophthalmol 1997;42:99â??123.Bibliographic Links

Roy FH. Ocular syndromes and systemic diseases, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2002.

Paradoxical Pupillary Reaction (Constricts when Light is Withdrawn)

1. Best disease

2. *Congenital achromatopsia

3. *Congenital stationary night blindness

4. Leber congenital amaurosis

5. Optic nerve hypoplasia

6. Retinitis pigmentosa

Barricks ME, et al. Paradoxical pupillary responses in congenital stationary night blindness.

Arch Ophthalmol 1977;95:1800â??1804.Bibliographic Links

Flynn JT, et al. Paradoxical pupil in congenital achromatopsia. Int Ophthalmol 1981;2:91â??96.Bibliographic Links

Frank JW, et al. Paradoxic pupillary phenomena. Arch Ophthalmol 1988;106:1564.Bibliographic Links

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Absence or Decrease of Pupillary Reaction to Light

This type of absence or decreased pupillary reaction to light is caused by drugs, including the following: