Pupil abnormalities

Introduction The pupil has a wide connection with various parts of the body. Its opening and contraction are affected by various factors, and its changes are clinically important. When the diameter of the sputum is greater than 5 mm, and the sag is continuous, the sputum is said to be large. If the pupil diameter is less than 2mm, the pupil is said to be reduced. Sometimes through the change of the pupil, it can reflect some lesions in the body, and some lesions of the nervous system can also make a diagnosis based on the changes of the pupil.

Cause

1. The pupil dilated on the side of the pupil can be seen in the oculomotor nerve injury, the hippocampus hook back or the sympathetic nerve stimulation, eye trauma, and vision loss. Bilateral pupil dilated can be found in midbrain lesions, central nervous system infectious diseases, cerebrovascular diseases, cerebral hypoxia, brain tumors, craniocerebral trauma, drug poisoning (such as atropine, etc.), pain, fear, hyperthyroidism, congenital Sexual abnormalities, etc.

2, pupil dilation a dilated pupil can be seen in the oculomotor nerve stimulation, cervical sympathetic nerve damage, corneal intraocular foreign body and so on. The pupils on both sides are reduced, which can be seen in infants and the elderly. Syphilis, pons, cerebrovascular disease, drug poisoning (morphine poisoning), organophosphate poisoning, etc.

3, the pupil does not wait for the large side of the oculomotor nerve paralysis, skull base lesions, brain or midbrain lesions, brain sympathetic nerve paralysis.

an examination

Related inspection

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First, medical history

Patients with abnormal pupils are less likely to find out on their own. They are often found by others or in the mirror. It should be noted whether the time of discovery is continuous or intermittent. How do you find out whether the disease progresses quickly or slowly? Is it monocular or binocular, or alternating? .

The history of pupil abnormalities should be noted that systemic diseases such as hypertension can occur in aneurysms, arteriosclerosis, cerebrovascular disease, diabetes, syphilis, hyperthyroidism and chronic alcoholism, and other factors that are associated with extraocular muscle paralysis. And pay attention to neck disease, lung disease, pharyngeal disease, history of brain trauma and tumor history.

The history of drug application, such as atropine expansion, atropine, scopolamine, belladonna, adrenaline, etc.; causes pupillary reduction factors such as organic phosphorus poisoning, cervical sympathetic nerve palsy, bridge brain lesions. And pay attention to the presence or absence of ophthalmic dilatation or stenosis examination or treatment.

Pay attention to the nervous system conditions such as headache, nausea, vomiting, cerebrovascular disease, brain tumors, facial sweating, and whether the objects are clear.

Second, physical examination

1, general examination: pay attention to body temperature, fever is mostly for some infectious diseases such as cavernous sinus thrombosis, encephalitis, meningitis; eyeball protrusion can be seen in cavernous sinus thrombosis, intraorbital tumor, carotid cavernous fistula; see the murmur in the eye Arterial cavernous sinus fistula; eye, neck or brain trauma; neck and pharynx with or without tumor, inflammation, enlarged lymph nodes.

2, pupil: is enlarged or reduced, is one side or both sides, direct and indirect light reflection, eye split size, eyeball protrusion, congestion, eye movement function is affected, vision and vision, whether there is double vision Abnormal eye movements and abnormalities in convergence, such as movement, sensation and sweating in the same side, and edema, congestion and atrophy in the fundus. Other signs of nervous system localization such as limb paralysis, paresthesia, autonomic dysfunction, etc.

Third, auxiliary inspection

1, brain or eye CT or MRI: check for brain tumors, inflammation, blood clots, vascular malformations, brain stem lesions, medullary cavity and ankle tumors, inflammation and so on.

2. Spinal MRI: Check for syringomyelia, tumor, inflammation, etc.

3, thyroid examination, blood glucose examination, X-ray examination of the neck, lungs and pharynx and histopathological examination.

Differential diagnosis

The pupil is like a serrated or plum-shaped shape: the scorpion is dry and missing, meaning that the pupil loses a perfect circle, and the chasing edge is like a sawtooth or plum-like shape. The consequences of serious illness can eventually lead to blindness.

Pupils turn white: the pupil area changes from black to white, the most common cause is senile cataract. The most common cause is senile cataract, in addition to iridocyclitis, glaucoma, diabetes, eye trauma and other reasons. It is characterized by unclear or invisible objects.

Pupil deformation: refers to the abnormal shape of the pupil, or the abnormal reaction of the pupils on both sides. Normally round, both sides are equal, and the responses of the pupils on both sides are synchronized. It can be elliptical in glaucoma or intraocular tumors; the shape can be irregular when the iris is stuck. There are many factors that cause changes in pupil size, such as age, brightness of light, iris inflammation, glaucoma, intracranial lesions, poisoning, and drug effects.

White sputum sign: refers to a special symptom of white reflection in the pupil, which can be caused by a variety of intraocular diseases, often with severe visual impairment. The clear spherical conjunctiva on the surface of the eye reveals the magnetic white of the sclera, commonly known as "eye white"; the conjunctiva and scleral tissue appear bright red when the lesion, vasodilatation, congestion, congestion or subconjunctival hemorrhage, which not only reflects conjunctival inflammation, but also Common symptoms common to many eye diseases.

Aro hole: the performance of light reflection disappears, the regulation of the presence of reflection, damage to the light reflection path for the lesion in the anterior region of the apex. 1 The retina is sensitive to light, no blindness, ie no abnormalities in the retina and optic nerve; 2 dilated pupils (within 3 mm); 3 pupils disappeared from light reflex; 4 convergent, normalized reflex; 5 physostigmine drops cause dilatation And atropine eye enlargement is not complete; 6 pupil morphology abnormalities (irregular and marginal irregularities) and asymmetry; 7 these barriers are permanent, mostly bilateral, occasionally one side.

The pupil has yellow-white reflection: the symptoms of retinoblastoma, the tumor begins to grow in the eye when the external eye is normal, because the child is young, can not read whether there is visual impairment, so the early stage of the disease is generally not easy to be found by parents. When the tumor proliferates into the vitreous or near the crystal, a yellow light reflection will appear in the pupil area. X-ray film: calcification point is visible, or the optic nerve hole is enlarged. B-ultrasound: can be divided into two types of substantive and cystic, the former may be early tumors, the latter represents advanced tumors. CT examination: (1) high-density mass in the eye: (2) calcification plaque in the mass, 30 to 90% of cases have this finding as a basis for diagnosis; (3) thickening of the optic nerve, enlargement of the optic nerve hole, indicating that the tumor spreads to the brain .

Asymmetry of the pupil: refers to the pupils on both sides are not equal or asymmetrical. The pupil diameter is generally 2 to 5 mm, with an average of 4 mm, a minimum of 0.5 mm and a maximum of 8 mm.

The sides of the pupil are not equal: the long-term wear of the eye causes the deformation of the eye to cause the bilateral pupils to be different, mostly in women under 30 years old. The main symptoms are the loss of pupil and knee reflex. It manifests as a dilated pupil on one side, and the photoreaction and regulation response disappear. However, if the glare is continuously irradiated for more than half a minute, the pupil may be slowly reduced; if the eyes are concentrated for five minutes, the pupil may be slowly contracted. This phenomenon is also known as Adie's pupil or tonic pupil.

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