Pertinent Pupillary Problems Karl C. Golnik, MD Professor & Chairman University of Cincinnati & The Cincinnati Eye Institute Objectives 1. Describe parasympathetic and sympathetic pupillary pathway anatomy. 2. Identify a relative afferent pupillary defect 3. List the differential diagnosis of anisocoria. Outline I. Anatomy II. Examination III. Relative Afferent Pupillary Defect IV. Anisocoria This patient has? 1. Horner syndrome 2. 3rd nerve palsy 3. Right Relative Afferent Pupillary defect 4. Left Relative Afferent Pupillary Defect Afferent Anatomy Retina Optic Nerve Chiasm Midbrain (3rd nerve nucleus) Parasympathetic Efferent Anatomy 3rd nerve Ciliary Ganglion Iris Sphincter & Ciliary Body Consensual Light Response Consensual Light Response “Double Decussation” Sympathetic Anatomy hypothalamus spinal cord lung carotid artery cavernous sinus ’ iris dilator & Muller s Outline I. Anatomy II. Examination III. Relative Afferent Pupillary Defect IV. Anisocoria