12/5/2023 0 Comments Irregular pupil shape dogmuscles that contracts/dilates the iris, narrowing/enlarging the diameter of the pupil of the eye. Iris sphicnter muscles, sphincter pupillae and dilator pupillae. the pupil is usually irregular in shape and magnified examination shows evidence of muscle damage. inflammation and trauma to the iris sphincter are other causes of anisocoria. This occurs most commonly among hospital personnel and those exposed to atropine-containing plants. if parasympatholytic (atropine-like) chemicals come in contact with the conjunctiva by accidental (or deliberate!) instillation, they will deactivate the iris sphincter muscle and cause (often very wide) pupil dilation. ptosis is usually present but is always mild (2 mm or less).įor more information on horner's syndrome see ptosis in this section. horner's syndrome causes anisocoria in which the affected pupil is smaller, but both pupils react briskly to light. however, anisocoria is never caused by a third nerve palsy unless there are other signs of a third cranial nerve palsy-ptosis, reduced ocular movements, or ocular misalignment.Ī common cause of isolated anisocoria is a viral infection of the ciliary ganglion (adie's syndrome), an orbital structure that receives the parasympathetic component of the third cranial nerve. The major concern, as with ptosis, is a third cranial nerve palsy, especially one caused by an aneurysm. parasympathetic innervation failure causes a relatively dilated pupil that reacts sluggishly to direct light.I try very hard to do thorough assessments and I confused as to why I am the only one finding these anomalies? I can understand other nurses maybe not bothering to check but the MD? I feel like a fool for even mentioning it but I know I am not wrong, so why the brush off? I am not above error but when three nurses agree, why not the MD? anyone else experience this? Any advice would be welcome.Īnisocoria, or a difference in the diameter of the pupils in dim illumination, may be physiologic if the difference is less than 1 mm and both pupils react briskly and equally to light. Is this normal for the elderly? I have done dozens of google searches and only found congenital or trauma related problems correlating with abnormal pupil shape or response. I have even had my findings double checked by an RN and she agreed with my assessment but the MD doesn't? I spoke with one of the nurses and she said " Oh that's how so and so always is, so i put perrla because its nothing out of the ordinary." Low and behold the resident still has an oblong pupil or fixed? The next time I work I see that the MD has found no problems and documents everything as normal ( including perrla) as well as the nurse continuing to document perrla. According to the H&P this is a new onset, I put them on the MD list after calling the MD and being told to do so. I work in a LTC facility and have noticed on several residents during my initial assessment and neuro check that one of the pupils is either irregular in shape and or abnormal pupil response.
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