DR Medhat MRCP

سؤال مهم : Ptosis o
Causes of bilateral ptosis
1. Myotonic dystrophy.
2. Myasthenia gravis.
3. Syphilis.
4. Congenital.
Causes of unilateral ptosis
1. Third nerve palsy (dilated pupil).
2. Horner`s syndrome (constricted pupil)
Argyll-Robertson pupil (ARP) :
- Miotic,irregular,eccentric pupil
- Reactive to accommodation but
Not to light reflex (whore)
- Causes : Syphilis
Sarcoidosis
DM
M.S
Pin-point pupil(< 2 mm under normal light) :
• Causes :
- Pontine hemorrhage
- Opiate (morphine) toxicity.
- Organophosphorous poisoning
Argyll-Robertson pupil (whore`s eye) i.e
( accommodate but doesn`t react)
Remember :
Painful occulomotor nerve palsy = posterior communicating artery aneurysm
B. Mydriasis : causes
هام جدا pupil) 1. Occulomotor nerve palsy (dilated fixed
2. Marcus –Gunn pupil : in early optic nerve lesion
3. Holmes-Adie`s pupil : unilateral (80%) ,dilated, non-reactive to light , slow
accommodation, in females &associated with absent leg reflexes .
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