STUDY - Technical - New Dacian's Medicine
Mydriasis
(Classical / Allopathic Medicine)
Mydriasis -
pupillary dilation caused by contraction of the dilator of the
iris - is a normal response to decreased light, strong
emotional stimuli, and topical administration of mydriatic and
cycloplegic drugs. It can also result from an ocular or
neurologic disorder, eye trauma, or a disorder that decreases
the level of consciousness. Mydriasis may be an adverse effect
of antihistamines or other drugs.
ALERT:
If mydriasis is accompanied by a change in the level of consciousness:
- quickly take the patient's vital signs
- assess him for other changes in neurological status, such as headache, aphasia, or hemiplegia
- institute emergency measures, if appropriate.
If the patient's condition permits, perform a focused assessment.
If mydriasis is accompanied by a change in the level of consciousness:
- quickly take the patient's vital signs
- assess him for other changes in neurological status, such as headache, aphasia, or hemiplegia
- institute emergency measures, if appropriate.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient about other eye problems, such as pain, blurring, diplopia, and visual field defects.
Review the patient's medical history, noting especially eye or head trauma, glaucoma and other ocular problems, and neurologic and vascular disorders.
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 about other eye problems, such as pain, blurring, diplopia, and visual field defects.
Review the patient's medical history, noting especially eye or head trauma, glaucoma and other ocular problems, and neurologic and vascular disorders.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Grading pupil size
To ensure an accurate evaluation of pupillary size, compare the patient's pupils with the scale at right. Keep in mind that maximum constriction may be less than 1 mm and maximum dilation greater than 9 mm.
PHYSICAL ASSESSMENT:
Inspect and compare the pupils’ size, color, and shape - many people normally have unequal pupils. (See Grading pupil size.)
Test each pupil for light reflex, consensual response, and accommodation. Perform a swinging flashlight test to evaluate a decreased response to direct light coupled with a normal consensual response (Marcus Gunn pupil).
Check the eyes for ptosis, swelling, and ecchymosis.
Test visual acuity in both eyes with and without correction.
Evaluate extraocular muscle function by checking the six cardinal fields of gaze.
To ensure an accurate evaluation of pupillary size, compare the patient's pupils with the scale at right. Keep in mind that maximum constriction may be less than 1 mm and maximum dilation greater than 9 mm.
PHYSICAL ASSESSMENT:
Inspect and compare the pupils’ size, color, and shape - many people normally have unequal pupils. (See Grading pupil size.)
Test each pupil for light reflex, consensual response, and accommodation. Perform a swinging flashlight test to evaluate a decreased response to direct light coupled with a normal consensual response (Marcus Gunn pupil).
Check the eyes for ptosis, swelling, and ecchymosis.
Test visual acuity in both eyes with and without correction.
Evaluate extraocular muscle function by checking the six cardinal fields of gaze.
SPECIAL
CONSIDERATIONS:
Keep in mind that mydriasis appears in two ocular emergencies: acute angle-closure glaucoma and traumatic iridoplegia.
Keep in mind that mydriasis appears in two ocular emergencies: acute angle-closure glaucoma and traumatic iridoplegia.
PEDIATRIC
POINTERS:
Mydriasis occurs in children as a result of ocular trauma, drug effects, Adie's syndrome, and, most commonly, increased intracranial pressure.
Mydriasis occurs in children as a result of ocular trauma, drug effects, Adie's syndrome, and, most commonly, increased intracranial pressure.
PATIENT
COUNSELING:
If the patient's mydriasis is the result of mydriatic drugs received during an eye examination, explain to the patient that he'll likely experience some photophobia and loss of accommodation. Instruct him to wear dark glasses and to avoid bright light, and reassure him that the condition is only temporary.
If the patient's mydriasis is the result of mydriatic drugs received during an eye examination, explain to the patient that he'll likely experience some photophobia and loss of accommodation. Instruct him to wear dark glasses and to avoid bright light, and reassure him that the condition is only temporary.
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.