The miotic pupil of Horner syndrome should be recognized and confirmed with topical apraclonidine testing.Īround 200 A.D., Galen likened the iris to an elastic circular ring that was passively inflated or deflated by vital spirits sent from the brain to enhance vision.The mydriatic pupil of oculomotor palsy must be distinguished from “isolated” pupil disturbances, including tonic (Adie) pupil and pharmacologic and traumatic (including intraocular surgery) mydriasis.The pupil examination includes: (1) swinging flashlight test to determine the presence of a relative afferent pupillary defect and (2) measurement of pupil size in dim illumination and constriction to light and a near target.
A “low tech” algorithm leads the clinician through the evaluation process to know whether the patient can be reassured or needs additional testing. The author discusses causes of anisocoria and abnormal pupillary activity. Does the patient have an aneurysm or is it just physiologic anisocoria? The pupil exam is to the eye what the deep tendon reflexes are to the neurologic exam: an objective and easily elicitable measurement.
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