Pupillary constriction: Difference between revisions
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{{Search infobox}} | {{Search infobox}} | ||
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==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]]. | 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<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>=== | |||
*[[Adie's pupil]] (long standing) | *[[Adie's pupil]] (long standing) | ||
| Line 40: | Line 25: | ||
=== History and Symptoms === | === History and Symptoms === | ||
*Specific medicinal and surgical history | *Specific medicinal and surgical history | ||
:* | :*Attention to neurologic, opthalmologic and otolaryngologic | ||
===Physical Examination=== | |||
==== Eyes ==== | ====Eyes==== | ||
*Pupil size in light and dark | *Pupil size in light and dark | ||
*Pupil response to light and convergence | *Pupil response to light and convergence | ||
*lid position | *lid position | ||
===Laboratory Findings === | |||
=== Laboratory Findings === | |||
*Labs include | *Labs include | ||
:*Rapid plasma reagin | :*Rapid plasma reagin | ||
:*VDRL | :*VDRL | ||
:*FTA-ABS | :*FTA-ABS | ||
=== MRI and CT === | === MRI and CT === | ||
*Chest CT if Horner's syndrome is found & to rule out apical lung mass | *Chest CT if Horner's syndrome is found & to rule out apical lung mass | ||
*MRI of head and neck if necessary | *MRI of head and neck if necessary | ||
=== Other Imaging Findings === | === Other Imaging Findings === | ||
*Carotid Doppler | *Carotid Doppler | ||
*Carotid Angiogram | *Carotid Angiogram | ||
== Treatment == | == Treatment == | ||
===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== | |||
{{ | {{reflist|2}} | ||
[[Category:Signs and symptoms]] | [[Category:Signs and symptoms]] | ||
[[Category:Physical examination]] | [[Category:Physical examination]] | ||
Revision as of 20:22, 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