Pupillary constriction: Difference between revisions
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===Medical Therapy=== | ===Medical Therapy=== | ||
*Administer high dose IV penicillin for syphillis | *Administer high dose IV penicillin for syphillis | ||
== Primary Prevention == | ===Primary Prevention=== | ||
*Remove problem causing medications | *Remove problem causing medications | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 20:23, 20 February 2013
Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Under control of the parasympathetic system, pupillary constriction is an act of the iris constrictor muscle. The abnormal pupil may appear smaller if parasympathetic action goes unopposed. The presence of pupillary constriction should prompt an immediate evaluation for acute Horner's syndrome.
Causes
Causes in Alphabetical Order[1][2]
- Adie's pupil (long standing)
- Argyll Robertson Pupils
- Anisocoria
- Coma
- Horner's Syndrome
- Iritis
- Posterior iris synechiae
- Systemic opioids
- Systemic cholinergics
- Tertiary Syphillis
- Topical cholinergics
Diagnosis
History and Symptoms
- Specific medicinal and surgical history
- Attention to neurologic, opthalmologic and otolaryngologic
Physical Examination
Eyes
- Pupil size in light and dark
- Pupil response to light and convergence
- Lid position
Laboratory Findings
- Labs include
- Rapid plasma reagin
- VDRL
- FTA-ABS
MRI and CT
- Chest CT if Horner's syndrome is found & to rule out apical lung mass
- MRI of head and neck if necessary
Other Imaging Findings
- Carotid Doppler
- Carotid Angiogram
Treatment
Medical Therapy
- Administer high dose IV penicillin for syphillis
Primary Prevention
- Remove problem causing medications