A diagnostic challenge

Çağlayan, Hale Zeynep Batur; Colpak, Ilksen A.; Kansu, Tülay

doi:10.1097/icu.0000000000000005

Cited by 26 publications

(21 citation statements)

References 43 publications

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“…Один из механизмов кратковременного угне-тения парасимпатической иннервации зрачка -проникновение в регионарный кровоток мест-ного анестетика [23,40,50], непреднамеренное попадание в конъюнктивальную полость атро-пина [14,65], ипратропия бромида из-под маски небулайзера при параличе мимической мускула-туры [15,16,53,63,70], скополамина и гиосцина при манипуляциях с купирующим тошноту/рвоту пластырем [14,28,39,49,61,76,78], сока луноц-вета, индейского дурмана и бругмансии [5,29,58] и даже порошкообразных стимулирующих пище-вых добавок [46]. В отличие от перечисленных выше фарма-кологических средств, диффузия ботулотокси-на за пределы таргетной зоны при выполнении лечебных или косметических процедур приводит к многонедельному расширению зрачка.…”

Section: Discussionunclassified

“…Тщательный сбор анамнеза, знание автоном-ной иннервации глазного яблока, причин (как физиологических, так и патологических) разви-тия одностороннего мидриаза позволяют адекват-но оценить этот симптом, существенно ускорить диагностический поиск, исключив необоснован-ные тревожные ожидания пациента и персонала, а также минимизировав выполнение дорогосто-ящих методик нейровизуализации [5,14,36 …”

Section: заключениеunclassified

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Unilateral mydriasis after video-assisted thoracic thymectomy: case report and review of literature

Panova

Юрьевна²,

Nikolaenko

et al. 2018

Ophthalmology Reports

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Section: Discussionunclassified

Section: заключениеunclassified

Unilateral mydriasis after video-assisted thoracic thymectomy: case report and review of literature

Panova

Юрьевна²,

Nikolaenko

et al. 2018

Ophthalmology Reports

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“…1 In the literature, it is reported that botulism is one of the causes for acquired mydriasis that could be transient or persistent. 2 Stool examination for botulinum toxin in our patient was negative.…”

Section: Discussionmentioning

confidence: 99%

Congenital Mydriasis: Diagnostic Challenge in a Case with Accompanying Neurologic Symptoms

Atik¹,

Koç²,

Kaplan³

et al. 2014

Neuro-Ophthalmology

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A 34-year-old woman was hospitalised with acute onset nausea, vomiting, ataxia, nystagmus, blurred vision, and bilateral mydriasis. Toxicologic investigations and serologic tests for infectious aetiologies were negative. Demyelinating disease was suspected based on magnetic resonance imaging (MRI) findings but there were no lesions at the midbrain explaining bilateral mydriasis. Direct light, consensual light, and near responses for pupil were all negative. Biomicroscopic examination of the iris did not show any sphincter damage or tonic movements. Pupils didn't respond to pilocarpine (0.1% and 2%) and remained unresponsive during the follow-up period. Congenital mydriasis was diagnosed because old photographs revealed that pupils were dilated previously.

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“…Examples of abnormal pupil reflex resulting from neurological problems includes Adie’s tonic pupil, Argyll Robertson Pupil and Horner’s syndrome. Furthermore, dilated pupils that are unresponsive or sluggish are indicative of medical conditions such as oculomotor nerve palsy, trauma, or inflammation (Caglayan et al, 2013). In a clinical setting PLR is examined by observation of the direct response elicited by light in the ipsilateral eye, and consensual response of the contralateral eye (Kaiser et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Infrared Video Pupillography Coupled with Smart Phone LED for Measurement of Pupillary Light Reflex

Chang

Turuwhenua

et al. 2017

Front. Integr. Neurosci.

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Clinical assessment of pupil appearance and pupillary light reflex (PLR) may inform us the integrity of the autonomic nervous system (ANS). Current clinical pupil assessment is limited to qualitative examination, and relies on clinical judgment. Infrared (IR) video pupillography combined with image processing software offer the possibility of recording quantitative parameters. In this study we describe an IR video pupillography set-up intended for human and animal testing. As part of the validation, resting pupil diameter was measured in human subjects using the NeurOptics™ (Irvine, CA, USA) pupillometer, to compare against that measured by our IR video pupillography set–up, and PLR was assessed in guinea pigs. The set-up consisted of a smart phone with a light emitting diode (LED) strobe light (0.2 s light ON, 5 s light OFF cycles) as the stimulus and an IR camera to record pupil kinetics. The consensual response was recorded, and the video recording was processed using a custom MATLAB program. The parameters assessed were resting pupil diameter (D1), constriction velocity (CV), percentage constriction ratio, re-dilation velocity (DV) and percentage re-dilation ratio. We report that the IR video pupillography set-up provided comparable results as the NeurOptics™ pupillometer in human subjects, and was able to detect larger resting pupil size in juvenile male guinea pigs compared to juvenile female guinea pigs. At juvenile age, male guinea pigs also had stronger pupil kinetics for both pupil constriction and dilation. Furthermore, our IR video pupillography set-up was able to detect an age-specific increase in pupil diameter (female guinea pigs only) and reduction in CV (male and female guinea pigs) as animals developed from juvenile (3 months) to adult age (7 months). This technique demonstrated accurate and quantitative assessment of pupil parameters, and may provide the foundation for further development of an integrated system useful for clinical applications.

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A diagnostic challenge

Abstract: The causes of pupillary dilatation can be unilateral, bilateral, and transient. The clinical approach to dilated pupils requires stepwise evaluation, and based on the findings, unnecessary and costly procedures can be avoided.

Cited by 26 publications

References 43 publications

Unilateral mydriasis after video-assisted thoracic thymectomy: case report and review of literature

Unilateral mydriasis after video-assisted thoracic thymectomy: case report and review of literature

Congenital Mydriasis: Diagnostic Challenge in a Case with Accompanying Neurologic Symptoms

Infrared Video Pupillography Coupled with Smart Phone LED for Measurement of Pupillary Light Reflex

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