tricky question: pupils !?

[xujunhao]

the other day, my assessor asked me a question:

Px comes in, after pupil assessment, you got the following results:
Pupils Round, NOT equal, react to light and accommodation
RAPD=0, direct yes, consential yes
no ptosis at all

(so, only anisocoria)

the question is, how would you determine which is the abnormal pupil?

I have done some research about this question, and I have asked a number of people, but got no answers, help!

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[DawgOD]

the one that dilates the least with direct light?

 

[JMU07]

Why does one pupil have to be abnormal? If both pupils constrict the same amount with light, that could just be normal for them.

Look at each pupil individually. Does the smaller one dilate when you turn the lights off? Does the larger one constrict when you shine your light in it?

 

[xujunhao]

I have already tried those answers... but he said it was wrong...

he said the answer is very simple

 

[admiralbean]

The pupils are not equal in size but do they react equally (ie 2mm constriction with light OD, OS)?

 

[KHE]

the other day, my assessor asked me a question:

Px comes in, after pupil assessment, you got the following results:
Pupils Round, NOT equal, react to light and accommodation
RAPD=0, direct yes, consential yes
no ptosis at all

(so, only anisocoria)

the question is, how would you determine which is the abnormal pupil?

I have done some research about this question, and I have asked a number of people, but got no answers, help!

I would think that you would have to check the anisocoria and see if it's greater in dim or bright illumination.

However, based on the information given, if both pupils react equally to light then it would seem to me that there is no problem with the iris sphincter of either eye. So that would mean that the issue is with the iris dilator muscle and therefore the problem is in the eye with the smaller pupil.

The lack of ptosis would (I think) indicate a post ganglionic lesion.