STUDY - Technical - New Dacian's Medicine
Miosis
(Classical / Allopathic Medicine)
Miosis - pupillary
constriction caused by contraction of the sphincter muscle in
the iris - occurs normally as a response to fatigue, increased
light, and miotic drugs; as part of the eye's accommodation
reflex; and as part of the aging process (pupil size steadily
decreases from adolescence to about age 60). However, it can
also stem from an ocular or neurologic disorder, trauma,
systemic drug therapy, or contact lens overuse. A rare form of
miosis - Argyll Robertson pupils - can stem from tabes
dorsalis or any one of several neurologic disorders. Occurring
bilaterally, these miotic (often pinpoint), unequal, and
irregularly shaped pupils don't dilate properly with mydriatic
drug use and fail to react to light, although they do
constrict on accommodation.
HISTORY:
Ask the patient if he has experienced other ocular signs and symptoms. If so, have him describe their onset, duration, and intensity.
Ask the patient if he wears contact lenses.
Review the patient's medical history, noting especially trauma and serious systemic disease.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient if he has experienced other ocular signs and symptoms. If so, have him describe their onset, duration, and intensity.
Ask the patient if he wears contact lenses.
Review the patient's medical history, noting especially trauma and serious systemic disease.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Examine and compare both pupils for size (many persons have a normal discrepancy), color, shape, reaction to light, accommodation, and consensual light response.
Examine both eyes for additional signs, and then evaluate extraocular muscle function by assessing the six cardinal fields of gaze.
Test visual acuity in each eye, with and without correction, paying particular attention to blurred or decreased vision in the miotic eye.
Examine and compare both pupils for size (many persons have a normal discrepancy), color, shape, reaction to light, accommodation, and consensual light response.
Examine both eyes for additional signs, and then evaluate extraocular muscle function by assessing the six cardinal fields of gaze.
Test visual acuity in each eye, with and without correction, paying particular attention to blurred or decreased vision in the miotic eye.
SPECIAL
CONSIDERATIONS:
Certain topical drugs, such as acetylcholine, carbachol, demecarium bromide, echothiophate iodide, and pilocarpine, are used to treat eye disorders specifically for their miotic effect.
Certain topical drugs, such as acetylcholine, carbachol, demecarium bromide, echothiophate iodide, and pilocarpine, are used to treat eye disorders specifically for their miotic effect.
PEDIATRIC
POINTERS:
Miosis occurs frequently in the neonate because he's asleep or sleepy most of the time.
Bilateral miosis occurs in congenital microcoria.
Miosis occurs frequently in the neonate because he's asleep or sleepy most of the time.
Bilateral miosis occurs in congenital microcoria.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include a complete ophthalmologic examination and a neurologic workup.
Instruct the patient on what to expect from diagnostic testing, which may include a complete ophthalmologic examination and a neurologic workup.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.