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Antecdotal on pupil path12/2/2023 Hippus is the normal rhythmic pupillary oscillation commonly seen when light stimulates either eye. This balance is in constant flux, so that pupil sizes change symmetrically from moment to moment. The size of the pupils at any one moment is determined by the balance of the parasympathetic tone of the iris sphincter and the sympathetic tone of the iris dilator. Light directed into either eye normally produces bilateral pupillary constriction.Įach pupil receives both sympathetic (dilator muscle: active dilation) and parasympathetic (sphincter muscle: active constriction) innervation. The pupillary response in the eye that is not being illuminated is called the consensual response.ġ2.2 Clinical Anatomy and Physiology of the Pupils The pupillary response in the illuminated eye is called the direct response. Shining a light in one eye of a normal subject causes both pupils to constrict equally. When pupillary reactions are abnormal, slit lamp examination of the anterior segment and the iris may demonstrate abnormalities that may affect pupillary size and shape, such as synechiae, uveitis, iris tear, segmental contraction of the iris, iris tumor, and lens subluxation (▶Fig.
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