1. Manila Central University
Pupillary Disorders
OT 2-1 Group 5

2. OPTO 101, Physiological Optics
amaurotic pupil
Abstract
Pupillary abnormalities range from benign isolated findings to harbingers of significant, even life‐threatening, conditions. A
complete understanding of the neuroanatomy underlying the innervations to the antagonistic pupillary sphincter and dilator
muscles is essential to detecting, and discerning the importance of, a particular pupillary abnormality. The sphincter muscle
receives neuronal input from the parasympathetic division of the autonomic nervous system, whereas the dilator muscle
receives input from the sympathetic division. Afferent input carrying light information to the brain is transmitted by retinal
ganglion cell axons via the optic nerves, chiasm, and tracts. The parasympathetic innervation to the pupil originates in the
Edinger‐Westphal nucleus in the midbrain. The sympathetic innervation to the pupil consists of a three‐neuron pathway
originating in the hypothalamus. Important pupillary disorders include physiologic anisocoria, relative afferent pupillary defect,
amaurotic pupil, Argyll Robertson pupils, cranial nerve III palsy, pharmacologic mydriasis, tonic pupil, and Horner
syndrome.
Amaurotic pupillary defect is the term applied to an eye that does not even see light owing to severe unilateral retinal or
optic nerve disease. Obviously, a blind eye would not have a direct light response, nor could it induce a consensual response
in the normal eye. However, a light shown directly into the normal eye would induce a direct response there and a
consensual response in the blind eye.
Amaurotic pupillary response.
Pupillary Disorders
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3. OPTO 101, Physiological Optics
History
Amaurotic pupil. An eye having an amaurotic pupil (having no light perception) will have no direct pupillary reflex but will
contract consensually when the fellow (normal) eye is stimulated by light. The fellow eye, when stimulated, will react to light
but will not react consensually when the amaurotic eye is stimulated. The near reflex will be present for both eyes.
Test
Amaurotic pupillary reaction:
We swing the light from the diseased eye to normal eye to the diseased eye again. We find lost direct, normal indirect and
unsustained direct light reflexes.
This occurs in cases of unilateral complete damage of retina or optic nerve (no PL) while motor pathway is intact. Examples
are:
- Unilateral complete optic atrophy.
- CRAO.
- Unilateral absolute glaucoma.
- Old standing retinal detachment or CRAO with complete retinal atrophy an no PL.
Abnormal Pupils:
Amaurotic, "blind eye," with no light perception as a result of an optic nerve lesion.
A.) Pupils are of equal size.
B.) Neither pupil reacts when the defective eye is stimulated.
1.) There is no direct light response.
2.) There is no consensual light response to the contralateral eye.
C.) Both pupils react when the contralateral eye is stimulated.
1.) Direct light response is present.
2.) Consensual light response is present.
D.) Near reflex is normal.
Symptoms
absolute afferent pupillary defect:
Blind eye has no direct reaction to light
Both pupils are equal in size
Does react consensually
Normal eye has a good direct reaction to light Does not react consensually
Near reflex is normal in both eyes
Management
No immediate treatment of proven benefit
Pupillary Disorders
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4. OPTO 101, Physiological Optics
Terms
CRAO, or Central Retinal Artery Occlusion is a condition in which there is irreversible damage to the retinal rods and cones,
cells which process light into electrical stimulus for the brain to understand, as a result of complete stoppage of blood flow.
Within 6 hours, the retina becomes damaged, if immediate measures are not taken to prevent full stoppage of blood supply.
The cause usually is a problem with the heart or blood vessels supplying blood to the eye. Factors which can increase the
risk for CRAO are pregnancy, high cholesterol, obesity, diabetes, hypertension, and some medicines like oral contraceptive
pills. The cardiologist has to enquire into great detail for such history and investigate accordingly. This is to prevent such
episode from occurring in the other eye or brain.
PERRLA pupils equal, round, and reactive to light and accommodation.
Optic Nerve Disease – Damage to the optic nerve typically causes permanent and potentially severe loss of vision, as well as
an abnormal pupillary reflex, which is diagnostically important.
The type of visual field loss will depend on which portions of the optic nerve were damaged. In general:
• Damage proximal to the optic chiasm causes loss of vision in the visual field of the same side only.
• Damage in the chiasm causes loss of vision laterally in both visual fields (bitemporal hemianopia). It may occur in large
pituitary adenomata.
• Damage distal to the chiasm causes loss of vision in one eye but affecting both visual fields: The visual field affected
is located on the opposite side of the lesion.
GROUP 5 PRESENTER:
CARL JOSELLE R. CAPULONG
MACLESTER MANAHAN
ENRICO M. ABESAMIS
HANCEL M. DARROCA
SIGFRED AOAS
JOVELYN CANETE
SNEHAL THAPA
ALLEN HUBERT UY LIM
Pupillary Disorders
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