II. Physiology: Pupil Constriction as a normal response
- Images
- Parasympathetic stimulation
- Parasympathetic fibers course with CN 3
- Parasympathetic fibers originate in Edinger-Westphal Nucleus and transmit to ciliary Ganglion
- Bright light results in bilateral Pupil Constriction
- Direct reaction to light in exposed eye
- Light strikes Retina of affected eye
- Signal passed via Optic Nerve to Midbrain
- CN 3 associated parasympathetic fibers signal same iris to constrict
- Consensual Light Reaction in opposite eye
- Direct reaction to light in exposed eye
- Accommodation
- Visual focusing
- Near Reaction (e.g. Reading)
- Also results in eye convergence (under CN 3 control as well)
- Near Reaction (e.g. Reading)
- Pathway
- Ciliary body Smooth Muscle contracts
- Lens changes shape (more convex)
- Pupil constricts during accommodation to aid focusing
- Both ciliary body contraction and Pupil Constriction are mediated by CN 3 related parasympathetic fibers
- Visual cortex controls accommodation as part of a reflex loop based on Optic Nerve signals
- Visual focusing
III. Causes: Abnormal Miosis
- Horner's Syndrome
- Mnemonic: COPS
- Cholinergic Toxicity
- Clonidine
- Opioids (e.g. Heroin, Morphine)
- Organophosphate Toxicity
- Phenothiazines
- Pilocarpine
- Pontine bleed or lesion
- Sedative-Hypnotics (e.g. Benzodiazepines)
- Pinpoint Pupils (Miosis) AND respiratory depression, Altered Mental Status and Bradycardia
- Pontine Hemorrhage
- Organophosphate Poisoning
- Imidazoline Poisoning
- Clonidine Overdose (including Clonidine patch)
- Child ingestion of topicals: Oxymetazoline (Afrin), Naphazoline (Visine)
- Dexmedotomidine (e.g. veterinary Anxiolytic medications)
IV. Causes: Other Abnormalities
-
Syphilitic Pupil (Argyll-Robertson Pupil, Prostitute's Pupil)
- See Neurosyphilis
- Mnemonic (Prostitute's Pupil): Pupil accomodates but does not react
- Pupil constricts during accommodation, but does not constrict to light
- Due to Midbrain lesion (superior colliculus, pretectal region)
- Typically bilateral lesions resulting in small, irregular pupils
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | The dioptric adjustment of the EYE (to attain maximal sharpness of retinal imagery for an object of regard) referring to the ability, to the mechanism, or to the process. Ocular accommodation is the effecting of refractive changes by changes in the shape of the CRYSTALLINE LENS. Loosely, it refers to ocular adjustments for VISION, OCULAR at various distances. (Cline et al., Dictionary of Visual Science, 4th ed) |
| Definition (PSY) | Process of focusing an image on the retina by means of a flattening or bulging of the lens. |
| Definition (CSP) | adjustment of the lens of the eye for various distances. |
| Concepts | Clinical Attribute (T201) |
| MSH | D000065 |
| SnomedCT | 251776000, 28365007, 246718000 |
| English | Accommodation, Ocular, eye accommodation, Visual Focusing, Visual accommodation, Accommodation, Acc - Accommodation, focusing, accommodation, accommodations, ocular accommodation, accommodation eye, accommodations eye, visual accommodation, Visual accommodation (observable entity), Ability to change between near and distance vision, Ocular accommodation, Ocular accommodation (observable entity), Visual Accommodation, Visual accommodation, NOS, Focusing (Visual), Eye Accommodation, Ocular Accommodation, Distance Accommodation, Ocular, Ocular Distance Accommodations, Ocular Distance Accommodation, Accommodation, Ocular Distance |
| Spanish | acomodación, acomodación visual (entidad observable), acomodación visual, acomodación ocular (entidad observable), acomodación ocular, Acomodación Ocular |
| French | Accommodation de l'oeil, Accommodation des yeux, Accommodation oculaire |
| Swedish | Ackommodationsförmåga |
| Czech | akomodace oční |
| Finnish | Silmien mukautuminen |
| Russian | AKKOMODATSIIA GLAZA, АККОМОДАЦИЯ ГЛАЗА |
| Japanese | 眼球調節作用, 眼の調節, 調節作用-眼球, 調節-眼 |
| Polish | Akomodacja, Nastawność oka, Akomodacja oka |
| Norwegian | Akkommodasjon, Akkommodasjon, øye |
| German | Augenakkomodation, Akkomodation, okuläre |
| Italian | Accomodazione oculare |
| Dutch | Accommodatie, Accommodatie, lens-, Lensaccomodatie |
| Portuguese | Acomodação Ocular |
Ontology: Miosis disorder (C0026205)
| Definition (MSHCZE) | Zúžení zornice (pupily). K m. dochází při zvýšené intenzitě světla (slunce, silné žárovky) a je ochrannou reakcí oka. Je zprostředkována stahem hladkého svalu v duhovce (iris) v důsledku působení parasympatického nervového systému. Kromě působení světla m. vyvolávají i látky či léky zesilující působení parasympatiku (morfin). M. snižuje nitrooční tlak, proto se v léčbě glaukomu užívají léky, které ji vyvolávají – miotika. Opak mydriáza. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (MSH) | Pupillary constriction. This may result from congenital absence of the dilatator pupillary muscle, defective sympathetic innervation, or irritation of the CONJUNCTIVA or CORNEA. |
| Concepts | Finding (T033) |
| MSH | D015877 |
| ICD9 | 379.42 |
| SnomedCT | 194166000, 61514009, 63251006 |
| English | Mioses, Miosis, MIOSIS, PUPILS CONSTRICTED, Small pupil, Miosis disorder, Constricted Pupil, Constricted Pupils, Pupil, Constricted, Pupils, Constricted, Mioses, Persistent, Miosis, Persistent, Persistent Mioses, Persistent Miosis, Mioses, Pupillary, Miosis, Pupillary, Pupillary Mioses, Pupillary Miosis, Pupil, Small, Pupils, Small, Small Pupil, Small Pupils, Miosis not d/t miotics, Miosis [Disease/Finding], constrict pupils, constricted pupil, constricted pupils, mioses, miosis disorder, pupillary miosis, small pupil, pupil constrict, Small pupils, Miosis (disorder), small pupils, small pupils (diagnosis), miosis persistent, Persistent miosis (diagnosis), Persistent miosis, Persistent miosis (disorder), miosis, myosis, Miosis, NOS, Persistent miosis [Ambiguous], Miosis (persistent), not due to miotics, Miosis, not due to miotics, Persistent miosis, not due to miotics |
| French | MYOSIS, Miosis (persistant), non dû à des myotiques, RETRECISSEMENT DE LA PUPILLE, Myosis, Constriction pupillaire, Myosis pupillaire |
| Portuguese | MIOSE, Miose persistente não causada por mióticos, CONTRACCAO DAS PUPILAS, Miose, Miose Pupilar |
| Spanish | MIOSIS, Miosis (persistente) no producida por mióticos, PUPILAS CONTRAIDAS, miosis (trastorno), miosis, constricción de las pupilas, miosis persistente (trastorno), miosis persistente, Miosis, Miosis Pupilar |
| Dutch | miosis (persisterend), niet door miotica, miose, Miose, Pupilmiose |
| German | Miosis (persistierend), nicht durch Miotika verursacht, MIOSIS, PUPILLENVERENGUNG, Miose, Stenokorie, Pupillenverengung, Miosis |
| Italian | Miosi (persistente), non dovuta a miotici, Pupilla piccola, Miosi persistente, Restringimento del diametro pupillare, Miosi pupillare, Miosi |
| Swedish | Pupillsammandragning |
| Japanese | ｼｭｸﾄﾞｳ, 瞳孔縮小, 縮瞳 |
| Czech | mióza, Mióza, Mióza ( perzistentní), nevyvolaná miotiky |
| Finnish | Mioosi |
| Russian | MIOZ, МИОЗ |
| Polish | Zwężenie źrenicy |
| Hungarian | Pupillaszűkület (persistáló), nem pupillaszűkítő okozta, Pupillaszűkület |
| Croatian | MIOZA |
| Norwegian | Miose, Pupillkontraksjon, Pupillsammensnøring |
Ontology: Ocular accommodation near point (C0429572)
| Concepts | Finding (T033) |
| SnomedCT | 251778004 |
| English | Ocular accommodation near point, Ocular accommodatn near point, NPA - Near point accommodation, Ocular accommodation near point (observable entity), NP - Near point, Near point |
| Spanish | punto cercano de acomodación ocular (entidad observable), punto cercano de acomodación ocular |
