DR Medhat MRCP

سؤال هام فى االمتحان : pupil • Disorders of the
A. Miosis (small pupil) :
Causes :
1. Horner`s syndrome.
2. Argyll-Robertson pupil.
3. Congenital miosis.
4. Senile miosis.
5. Pinpoint pupil (pontine hge,opiate toxicity,organophosphorus poison)
Horner`s syndrome (sympathetic lesion) :
- Ptosis (partial)
- Miosis .
- Anhydrosis
- Enophthalmos
- Lost spino-ciliary reflex
( normally ,bricking one side of the neck
ipsilateral mydriasis).
Left side Horner`s syndrome
(ptosis +miosis)
• Distinguishing it from other causes:
o Heterochromia (i.e difference
In iris colour) : in congenital
Horner.
notice the heterochromia (congenital)
o Anhydrosis can determine the site of lesion in Horner`s syndrome :
Central lesion Preganglionic lesion Postganglionic lesion
Anhydrosis Face,arm&trunk Only face No anhydrosis
Causes 1. Stroke.
2. Syringomyelia.
3. Multiple sclerosis
4. Encephalitis.
5. Tumors
1. Pancoast tumor.
2. Thyroidectomy.
3. Trauma.
4. Cervical rib.
1. Carotid artery dissection.
2. Carotid aneurysm.
3. Cavernous sinus thrombosis.
4. Cluster headache.
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