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Wydanie 2/2010
str. 108

Nierówność źrenic

Anisocoria

Martyna Pieniążek, Marek Szaliński, Marta Misiuk-Hojło

Katedra i Klinika Okulistyki Akademii Medycznej we Wrocławiu
Kierownik: dr hab. n. med., prof. nzw. Marta Misiuk-Hojło

Summary: Pupil size and reactivity evaluation is an essencial element of a neuroophthalmological examination. Physiological and pathological anisocoria can be described. Diagnostic hypothesis of pathologic anisocoria makes us proceed with further investigation. Testing pupillary function seems trivial, although may lead to health or life threatening findings. Crucial question is about pupillary light reflex, wheather the pupil reacts to light or not. Pathologic anisocoria in ophthalmologist’s practice is most commonly related to pupil abnormalities, concerning iris itself. Other cause of pathological anisocoria is impairment of autonomic innervation controlling pupil dilation and constriction (sympathetic or parasympathetic). Defects of afferent part of pupillary light reflex pathway doesn’t cause anisocoria. Anisocoria with intact pupillary light reflex suggests Horner Syndrome. Other findings include mild ptosis of upper lid and “reversed ptosis” of lower lid on the ipsilateral side, slow pupil dilation in darkness enhancing diameter difference between pupils, as well as poor sweating on the same side. Cocaine and apraclonidine tests confirm diagnosis. Tonic pupil is the most common cause of anisocoria with impaired pupillary light reflex. Segmental pupillary sphincter palsies are very typical. Absent or severely reduced light reaction and better but very slow near reaction (especially redilation) can be demonstrated. The diagnosis of a tonic pupil is primarily made by slit lamp study, although hypersensitivity to 0.1% pilocarpine confirms diagnosis. Today infrared video pupillography is the dominating method of pupil size and reactivity recording.

Słowa kluczowe: źrenica, nierówność źrenic, reaktywność źrenic, zespół Hornera, źrenica toniczna, pupillometria.

Keywords: pupil, anisocoria, pupil reactivity, Horner’s syndrome, tonic pupil, pupillometry.

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