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1、NeuroNeuro-Ophthalmology Division-Ophthalmology Division Department of Ophthalmology and Visual ScienceDepartment of Ophthalmology and Visual Science VA and University Hospital, Iowa City, Iowa VA and University Hospital, Iowa City, Iowa Causes of an Irregular Pupil the iris tissue itself muscle and
2、 stroma nerve causes segmental denervation or aberrant re-innervation of either parasympathetic or sympathetic nerves central nervous system (rare) midbrain “corectopia” and brainstem herniation Iris Causes of an Irregular Pupil Riegers ICE ICE Axonfelds/Riegers Sphincter tears Ischemia Zoster Post
3、surgical Coloboma Iris Synechia Ectropian Uveae Iris Tumor/Cyst The iris tissue itself muscle and stroma Nerve Causes of an Irregular Pupil postganglionic sympathetic denervation of the iris dilator light dark 3 seconds dark 8 seconds Nerve Causes of an Irregular Pupil postganglionic sympathetic den
4、ervation of the iris dilator and aberrant re-innervation of some dilator sectors light dark 5 seconds in dark, “swallowing” Nerve Causes of an Irregular Pupil postganglionic sympathetic denervation of the iris dilator and aberrant re-innervation of some dilator sectors light dark 5 seconds video in
5、dark, swallowing cold water Nerve Causes of an Irregular Pupil segmental sympathetic pulling on the dilator “tadpole pupil” Nerve Causes of an Irregular Pupil segmental sympathetic pulling on the dilator tadpole pupil video Dark Bright Light Near Chronic “Little Old Adies Pupil” Nerve Causes of an I
6、rregular Pupil abnormal parasympathetic innervation to the sphincter Infrared transillumination Infrared front illumination Dark Near 0.5% tropicamide CNS Causes of an Irregular Pupil Midbrain “Corectopia” Selhorst et al, Arch Neurol 33,193, 1976 The oval pupil: relationship to intracranial hyperten
7、sion Marshall et al, J Neurosurgery 58:566-568. 1983 brainstem herniation rare Causes of an Irregular Pupil the iris tissue itself muscle and stroma nerve causes segmental denervation or aberrant re-innervation of either parasympathetic or sympathetic nerves central nervous system (rare) midbrain “corectopia” and brainstem herniation
