Flow diagram for determining which efferent pupillary defect causes
Flow diagram for determining which
efferent pupillary defect causes anisocoria. By assessing pupil
size in darkness and bright room light, pupillary light reaction,
and iris structure, the cause of anisocoria can be determined with
the aid of a few pharmacologic agents. Because response to a given
pharmacologic eye drop varies among patients, the agent should be
administered bilaterally so that the responses of the affected
pupil and the normal one can be compared. Of note, the pupillary
supersensitivity to cholinergic agents, which stimulate the
sphincter, is generally greater for Adie’s pupil than for
third‐nerve palsy. With time, however, Adie’s pupil
progressively decreases in size; as a result, pharmacologic
supersensitivity becomes less profound, and segmental palsy becomes
less apparent .
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