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The pupil is a hole located in the center of the iris of the eye that allows light to strike the retina. [1] It appears black because light rays entering the pupil are either absorbed by the tissues inside the eye directly, or absorbed after diffuse reflections within the eye that mostly miss exiting the narrow pupil.
Anisocoria is a common condition, defined by a diameter difference of 0.4 mm or more between the sizes of the pupils of the eyes. [2] Anisocoria has various causes: [3] Physiological anisocoria: About 20% of the population has a slight
The main characteristic that distinguishes physiological anisocoria is an increase of pupil size with lower light or reduced illumination, such that the pupils differ in size between the two eyes. At any given eye examination, up to 41% of healthy patients can show an anisocoria of 0.4 mm or more at one time or another.
Nerves involved in the resizing of the pupil connect to the pretectal nucleus of the high midbrain, bypassing the lateral geniculate nucleus and the primary visual cortex. From the pretectal nucleus neurons send axons to neurons of the Edinger-Westphal nucleus whose visceromotor axons run along both the left and right oculomotor nerves .
The entrance pupil is typically about 4 mm in diameter, although it can range from 2 mm (f /8.3) in a brightly lit place to 8 mm (f /2.1) in the dark. The latter value decreases slowly with age; older people's eyes sometimes dilate to not more than 5–6mm in the dark, and may be as small as 1mm in the light. [26] [27]
Argyll Robertson pupils (AR pupils) are bilateral small pupils that reduce in size on a near object (i.e., they accommodate), but do not constrict when exposed to bright light (i.e., they do not react). They are a highly specific sign of neurosyphilis; however, Argyll Robertson pupils may also be a sign of diabetic neuropathy.
The American Journal of Critical Care revealed that critical care and neurosurgical nurses consistently underestimated pupil size, were unable to identify anisocoria, and incorrectly assessed pupil reactivity (sPLR). It concluded that automated pupillometry is a necessary tool for accuracy and consistency, and that it might facilitate earlier ...
Dilation and constriction of the pupil Pupillary response is a physiological response that varies the size of the pupil between 1.5 mm and 8 mm, [ 1 ] via the optic and oculomotor cranial nerve. A constriction response ( miosis ), [ 2 ] is the narrowing of the pupil, which may be caused by scleral buckles or drugs such as opiates / opioids or ...