![]() Not all third nerve palsies have pupil involvement. Over time, tonic pupils tend to become smaller (“little old Adies”).Ī completely isolated mydriasis is extremely unlikely to be related to a third nerve palsy and should be evaluated clinically and with pharmacologic testing to rule out an Adie pupil or pharmacologic mydriasis prior to obtaining any further workup. What may happen to the size of the pupil over time in the Adie syndrome? Mydriasis from isolated third nerve palsy is essentially always associated with an extraocular movement deficit (responsible for diplopia) and/or ptosis.Ĩ. Is isolated mydriasis likely to be caused by a 3rd nerve paresis? The ratio of fibers that serve accommodation compared with pupil constriction is about 30:1, there is an overwhelming amount of regenerating accommodative fibers that respond to a near stimulus but may aberrantly regenerate to the pupil sphincter muscle.ħ.
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