STUDY - Technical - New Dacian's Medicine
Pupils,
sluggish (Classical / Allopathic Medicine)
A
sluggish pupillary reaction is an abnormally slow
pupillary response to light. It can occur in one pupil or
both, unlike the normal reaction, which is always
bilateral. A sluggish reaction accompanies degenerative
disease of the central nervous system and diabetic
neuropathy. It can occur normally in elderly people, whose
pupils become smaller and less responsive with age.
To
assess pupillary reaction to light, first test the
patient's direct light reflex. Darken the room, and cover
one of the patient's eyes while you hold open the opposite
eyelid. Using a bright penlight, bring the light toward
the patient from the side and shine it directly into his
uncovered eye. If normal, the pupil will promptly
constrict. Next, test the consensual light reflex. Hold
both of the patient's eyelids open, and shine the light
into one eye while watching the pupil of the opposite eye.
If normal, both pupils will promptly constrict. Repeat
both procedures to test light reflexes in the opposite
eye. A sluggish reaction in one or both pupils indicates
dysfunction of cranial nerves II and III, which mediate
the pupillary light reflex.
HISTORY:
Ask the patient what type of eyedrops he's using, if any, and when they were last instilled.
Ask the patient if he's experiencing pain and, if so, ask him to describe its location, intensity, and duration.
Ask the patient what type of eyedrops he's using, if any, and when they were last instilled.
Ask the patient if he's experiencing pain and, if so, ask him to describe its location, intensity, and duration.
PHYSICAL
ASSESSMENT:
Test visual acuity in both eyes, using the Snellen chart.
Assess extraocular movements.
Determine whether the patient suffers from photosensitivity or photophobia.
Test the pupillary reaction to accommodation; the pupils should constrict equally as the patient shifts his glance from a distance to a near object.
Hold a penlight at the side of each eye and examine the cornea and iris for irregularities, scars, and foreign bodies. Estimate intraocular pressure (IOP) by placing your fingers over the patient's closed eyelid. If the eyeball feels rock hard, suspect elevated IOP.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs.
Test visual acuity in both eyes, using the Snellen chart.
Assess extraocular movements.
Determine whether the patient suffers from photosensitivity or photophobia.
Test the pupillary reaction to accommodation; the pupils should constrict equally as the patient shifts his glance from a distance to a near object.
Hold a penlight at the side of each eye and examine the cornea and iris for irregularities, scars, and foreign bodies. Estimate intraocular pressure (IOP) by placing your fingers over the patient's closed eyelid. If the eyeball feels rock hard, suspect elevated IOP.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs.
SPECIAL
CONSIDERATIONS:
A sluggish pupillary reaction isn't diagnostically significant, although it occurs with various disorders.
A sluggish pupillary reaction isn't diagnostically significant, although it occurs with various disorders.
PEDIATRIC
POINTERS:
Children experience sluggish pupillary reactions for the same reasons as adults.
Children experience sluggish pupillary reactions for the same reasons as adults.
PATIENT
COUNSELING:
Refer the patient to an opthalmologist if increased IOP is suspected.
Refer the patient to an opthalmologist if increased IOP is suspected.
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.