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

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

P.354

Anisocoria (Inequality of Pupils of â?¥1 MM)

1. Central nervous system

A.*Adie (tonic) pupil

B.Aneurysm of the aorta or carotid artery

C.Cerebrovascular accidents

D.Cervical rib (ipsilateral constricted pupil)

E.Encephalitis (mild cases)

F.*Horner syndrome (cervical sympathetic paralysis syndrome)

G.Pontine lesions

H.Tabes dorsalis

I.Third-nerve paresis

J.Trigeminal neuralgia (tic douloureux)

K.Wernicke hemianopic pupil

A.Artificial eye (pseudoanisocoria)

B.Cornea, such as keratitis or abrasion

C.Glaucoma, including pigmentary dispersion

D.*Iris, such as iritis, synechiae, iris atrophy, or iris sphincter rupture

E.Ocular trauma

F.Spastic miosis

4. Physiologic

A. Anisometropiaâ??larger pupil with the more myopic eye

B.Familial

C.Lateral illumination of one eye gives more miosis in that eye than in the other

D.Nonfamilialâ??normal variation (small percentage of the population)

E.Tournay reactionâ??with the eyes turned sharply to the side, dilatation of the pupil of the abducting eye and miosis of pupil of the adducting eye

5. Unilateral miosis (see p. 349)

6. Unilateral mydriasis (see p. 349)

Cheng MM, Catalano RA. Fatigue-induced familial anisocoria. Am J Ophthalmol 1990;109:480â??481.Bibliographic Links

Feibel RM, Perlmutter JC. Anisocoria in the pigmentary dispersion syndrome. Am J Ophthalmol 1991;111:384.Bibliographic Links

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

Nakagawa TA, et al. Aerosolized atropine as an unusual cause of anisocoria in a child with asthma. Pediatr Emerg Care 1993;9:153â??154.Bibliographic Links

Irregularity of Pupil (Including Oval or Peaked Pupil)

1. Adherent leukoma as one part of iris is pulled up to corneal scar, peripheral anterior synechiae, or corneal laceration with prolapse of iris

2. Alagille syndrome

3. Anterior chamber intraocular lens that is too long or erodes into uveal tissue

4. Argyllâ??Robertson pupilâ??small and irregular; reacts better to accommodation than to light; same type as seen in diabetic patients (pseudodiabetic pupil)

5. Congenital coloboma of the iris, usually below

6. Following laser iridectomy

7. Glaucomaâ??oval, dilated pupil

8. *Injury of the iris

9. Iris tuck of anterior chamber intraocular lens

10. *Iritisâ??usually small but pupil may be any shape with anterior or posterior synechiae 11. *Long-term intraocular inflammation

12. Medication, with faster reaction of one sector of iris than of anotherâ??miosis or mydriasis 13. Operationâ??as sector iridectomy or peripheral iridectomy

14. Optic atrophy due to causes such as syphilis, quinine poisoning, and internal ophthalmoplegia of vascular or traumatic origin

P.356

15. Piece of anterior capsule into anterior chamber

16. Posterior chamber intraocular lens with loop of intraocular lens holding the midportion of iris peripherally

17. Posterior chamber lens with two haptics having the lens either behind the pupil with the haptics in front or having the lens anterior to the pupil with the haptics behind the iris

18. Segmental iris atrophy

19. Tumors of iris or ciliary body

20. Vitreous or zonules into corneal laceration

21. Vitreous strand from behind pupil to wound 22. Wound leak with or without prolapse of the iris

Fuller JR. Iris creep producing correctopia in response to Molteno implants. Arch Ophthalmol 2001;119:304â??306.Bibliographic Links

Moster MR, et al. Laser iridectomy. Ophthalmology 1986;93:20â??24.Bibliographic Links

Newell FW. Ophthalmology: principles and concepts, 7th ed. St. Louis: CV Mosby, 1991.

Reidy JJ, et al. An analysis of semiflexible, closed-loop anterior chamber intraocular lenses.

Am Intraocular Implant Soc J 1985;11:344â??352.

Hippus

Hippus is visible, rhythmic, but irregular pupillary oscillations that are deliberate in time. It comprises 2 mm or more excursions and has no localizing significance.

1. Normal

2. Incipient cataracts

3. Central nervous system diseases, including the presence of total third cranial nerve palsy, hemiplegia, meningitis (acute), cerebral syphilis, tabes, general paralysis, myasthenia gravis, tumors of corpora quadrigemina, epileptics, Cheyneâ??Strokes breathing, multiple sclerosis (disseminated sclerosis), and cerebral tumors

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

Zinn KM. The pupil. Springfield, IL: Charles C Thomas, 1972.

Tonohaptic Pupil

Tonohaptic pupil involves a long latent period preceding both contraction to light and redilatation, followed in each instance by a short but prompt movement.

1. Catatonic state

2. Diabetes mellitus (Willis disease) P.357

3. Diabetes insipidus

4. Dystrophia adiposogenitalis (Fröhlich syndrome) or pituitary cachexia (Simmonds disease)

5. Introverted persons of the schizophrenic group

6. Parkinsonism (shaking palsy)

7. Pigmentary retinal dystrophy

8. Postencephalitic condition

9. Schizoid state

Duke-Elder S, Scott GI. System of ophthalmology, Vol 12. St. Louis: CV Mosby, 1971.

Leukokoria (White Pupil) (See Lesions Confused with Retinoblastoma, p. 502)