Different PUPLIS by drkbravva

Adie's pupil
A weak light reaction with segmental palsy of iris sphincter, a strong slow near response. an idiopathic postganglionic denervation of the parasympathetically innervated intraocular muscles, usually complicated by signs of aberrant regeneration of these nerves: See Also: tonic pupil. Syn: Adie's pupil, Holmes-Adie pupil, Holmes-Adie syndrome, pupillotonic pseudotabes.

Argyll Robertson pupil( absent reaction to pupillary light reflex & present reaction to accomodation ) a form of reflex iridoplegia characterized by miosis, irregular shape, and a loss of the direct and consensual pupillary reflex to light, with normal pupillary constriction to a near vision effort (light-near dissociation); often present in tabetic neurosyphilis. Syn: Robertson pupil.

Marcus Gunn pupil relative afferent pupillary defect. Syn: Gunn pupil.

Marcus Gunn jaw-winking is a form of synkinetic ptosis. An aberrant connection exists between the motor branches of the trigeminal nerve (CN V3) innervating the external pterygoid muscle and the fibers of the superior division of the oculomotor nerve (CN III) that innervate the levator superioris muscle of the upper eyelid. Electromyographic studies demonstrate this synkinetic innervation by showing simultaneous contraction of the external pterygoid and levator muscle. In these cases, the eyelid elevates on closing the mouth and clenching the teeth. jaw-winking ptosis. Jaw winking worse in downgaze o Decreased vision secondary to amblyopia o Strabismus + Vertical deviation, usually a hypotropia on involved side

Horner's pupil constricted pupil due to impairment of sympathetic nerve innervation of the dilator muscle of the pupil. See Also: Horner's syndrome.

causes of horners synd. include: -post. inf. cerebellar artery or basilar artery occlusion -MS -Hypothalamic lesions -cavernous sinus thrombosis -cervical cord, mediastinal or pancoast's tumour -Aortic aneurysm -Klumpke's paralysis -cervical lymph adenopathy

Horner synd. Shows= MAPEC.
M=Miosis,
A=Anhidrosis
P=Ptosis
E=Enphthalmoses
C=Loss of Ciliospinal reflex.

Amaroutic pupil:-pupil in an eye that is blind because of ocular or optic nerve disease; this pupil will not contract to light except when the normal fellow eye is stimulated with light.

Cat's eye pupil-
distorted, elongated pupil; usually due to anterior segment anomaly.

Hutchinson's pupil dilation of the pupil on the side of the lesion as part of a third nerve palsy; often due to herniation of the uncus of the temporal lobe through the tentorial notch.

Tonic pupil
a general term for a pupil with delayed, slow, long-lasting contractions to light and to a near vision effort, often with light-near dissociation; due to denervation and aberrant reinnervation of the iris sphincter; seen in various autonomic neuropathies and in Adie syndrome.

Tadpole-shaped pupil
n intermittent, brief distortion and dilation of a pupil that draws one part of the iris into a peak so that the pupil resembles a tadpole; a temporary, benign condition associated with migraine that may leave the patient with a Horner's syndrome.

LASIK

LASIK
Laser Assisted in-Situ keratomileusis (LASIK)
USED FOR: -
1. Myopic correction of = -1 to –20.00 diopters (-2 to –12 D; Parsons’), with up to 5 diopters of astigmatism
2. Hypermetropic corrections for +4.00
3. Central cornea thickness should be at least 500 microm.
CI: -
1. Unstable refractive error.(Refraction must be stable for 12-18 months)
2. Age less than 18 years.
3. iritis or scleritis, conjunctivitis, severe dry eye
4. Keratoconus. Cornea should not be excessive flat or steep.
5. Presence of a pacemaker
Preop’ly: -
Contact lens wear should be discontinued
--3 days before for soft contact lens wear prior to Lasik
--2 weeks before for rigid gas permeable lens wear prior to Lasik
PROCEDURE
1. A suction ring placed on the eyeball elevates IOP to about 60 mmHg (temporary blackout of vision occurs).
2. The microkeratome advances and creates an epithelial flap, which is hinged usually nasally.
3. EXCIMER LASER is used.
4. Leave behind residual corneal thickness of at least 250 microns.
5. Irrigate bed with saline and close the flap. No sutures. It sticks by itself.
6. Use antibiotics and steroid drops for about 1 week.
ENHANCEMENTS
· Enhancement LASIK (i.e. repeat procedure) can be performed but usually after 3 months of table refraction. Ref- internet notes and edited by drkbravva