Mydriasis: Difference between revisions

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(/* Causes in Alphabetical OrderSailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massach...)
(/* Causes in Alphabetical OrderSailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massach...)
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** [[Atropine]]
** [[Atropine]]
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** Noradrenaline
** Noradrenaline
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*** [[MDMA]]
*** [[MDMA]]
**[[Tricyclic antidepressant]]s  
**[[Tricyclic antidepressant]]s  
*[[Hallucinogens]]
*[[Seizure]]s
*[[Seizure]]s
*[[Serotonin syndrome]]
*[[Serotonin syndrome]]

Revision as of 21:38, 21 February 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

Overview

Mydriasis is an excessive dilation of the pupil due to disease, trauma or drugs. Normally, the pupil dilates in the dark and constricts in the light. A mydriatic pupil will remain excessively large, even in a bright environment. Sometimes colloquially referred to as a "blown pupil."

The opposite, constriction of the pupil, is called miosis.

Pathophysiology

There are two types of muscle that control the size of the iris: circular muscle and radial muscle. The former is innervated by the parasympathetic nervous system, the latter by the sympathetic nervous system. Sympathetic stimulation of α1 adrenergic receptors causes the contraction of the radial muscle, and subsequent dilation of the pupil. Conversely, parasympathetic stimulation cause contraction of the circular muscle and constriction of the iris.

The mechanism of mydriasis depends on the agent being used. It usually involves either a disruption of the parasympathetic nerve supply to the eye (which causes contraction of the pupil), or over activity of the sympathetic nervous system (SNS).

Causes

Common Causes

  • Mydriatic Drops: A mydriatic is an agent which induces dilation of the pupil. Drugs such as tropicamide are used in medicine to permit examination of the retina and other deep structures of the eye, and also to reduce painful ciliary muscle spasm (see cycloplegia). One effect of administration of a mydriatic is intolerance to bright light.
  • Physiological Response Indicating Interest: Pupillary response may also indicate interest in the subject of attention or sexual stimulation.[2]

Causes in Alphabetical Order[3][4]

Diagnostic Findings

History and Symptoms

  • Complete history with special attention to:
  • Neurologic
  • Ophthalmologic
  • Otolaryngologic

Physical Examination

Eyes

  • Pupil size (light & dark)
  • Pupil response to light and convergence
  • Lid position

MRI

Treatment

Medical Therapy

  • Adie's pupil - Pilcarpine .125% BID-QID
  • Migraines - pain meds, antidepressants, anticonvulsants, beta blockers, calcium channel blockers

Primary Prevention

  • Remove causative medication
  • Sunglasses to decrease light sensitivity

Related Chapters

References

  1. [1]
  2. {{Citation
    • | last1 = Hess | first1 = Eckhard H.
    • | last2 = Polt | first2 = James M.
    • | title = Pupil Size as Related to Interest Value of Visual Stimuli
    • | journal = Science
    • | volume = 132
    • | issue = 3423
    • | pages = 349
    • | date = 5 August 1960
    • | year = 1960
    • | doi = 10.1126/science.132.3423.349 }}
  3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  4. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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