Pupil Anomalies: Reactions and Red Flags

Weon Jun, OD, FAOO

COPE #19433-NO

Expires June 1, 2010

3 credits, $59

Section: Neuro-Optometry


Examination of the pupils is one of the most important neuro-ophthalmologic testing that evaluates the integrity of the anterior visual pathways (afferent) and the autonomic nervous system: parasympathetic (efferent pupillary pathways) and sympathetic pathways (oculosympathetic).  Pupil testing becomes an essential part of the eye examination when evaluating a patient with ophthalmic manifestations of neurologic impairment such as sudden loss of vision, diplopia or ocular pain.  Pupil anomalies could be critical signs of vision or life threatening conditions.  The pupillary light reflex is also used to asses the function of the brain stem in a comatose patient.  It is one of the brain stem reflexes tested in the determination of the brain death.  A thorough understanding and knowledge of the pupil testing and its underlying principles are keys to accurate diagnosis and proper management of patients with pupillary anomalies.  It is important you take a systematic approach when evaluating patient's pupils.  This online CE will serve to provide clinical and practical guidelines including clinical pearls in assessing and managing pupillary anomalies in clinic. 


Figure 9

Figure 9.  Third-nerve palsy with pupil involvement in the right eye:  the right pupil is non-reactive; complete ptosis, hypoexotropia, impaired adduction, elevation and depression in the right eye.  Image from http://www.atlasophthalmology.com/atlas/photo.jsf?node=5830&locale=en