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Visceromotor nerve axons (which constitute a portion of cranial nerve III, along with the somatomotor portion derived from the Edinger-Westphal nucleus) synapse on ciliary ganglion neurons, whose parasympathetic axons innervate the iris sphincter muscle, producing miosis.
Mydriasis is frequently induced by drugs for certain ophthalmic examinations and procedures, particularly those requiring visual access to the retina. Fixed, unilateral mydriasis could be a symptom of raised intracranial pressure. The opposite, constriction of the pupil, is referred to as miosis. Both mydriasis and miosis can be physiological.
Dilation and constriction of the pupil. Pupillary response is a physiological response that varies the size of the pupil, via the optic and oculomotor cranial nerve.. A constriction response (), [1] is the narrowing of the pupil, which may be caused by scleral buckles or drugs such as opiates/opioids or anti-hypertension medications.
Pinpoint pupils, or miosis, caused by opioids. Because of their effect on the part of the brain that regulates breathing, opioids can cause very slow or stopped breathing, during overdoses, leading to hypoxia [16] or death if left untreated. [1] Hypoxia is typically caused by respiratory depression.
When cycloplegic drugs are used as a mydriatic to dilate the pupil, the pupil in the normal eye regains its function when the drugs are metabolized or carried away. Some cycloplegic drugs can cause dilation of the pupil for several days.
The symptoms of an opiate toxidrome include the classic triad of coma, pinpoint pupils and respiratory depression [3] as well as altered mental states, shock, pulmonary edema and unresponsiveness. Complications include bradycardia, hypotension and hypothermia. Substances that may cause this toxidrome are opioids.
As a result of cholinergic crisis, the muscles stop responding to the high synaptic levels of ACh, leading to flaccid paralysis, respiratory failure, and other signs and symptoms reminiscent of organophosphate poisoning. Other symptoms include increased sweating, salivation, bronchial secretions along with miosis (constricted pupils).
Drugs with muscarinic antagonist activity are widely used in medicine, in the treatment of low heart rate, overactive bladder, respiratory problems such as asthma and chronic obstructive pulmonary disease (COPD), and neurological problems such as Parkinson's disease and Alzheimer's disease.