Pupillary constriction

Under control of the parasympathetic system, pupillary constriction is an act of the iris constrictor muscle. The abnormal pupil may appear smaller if parasympathetic action goes unopposed. The presence of pupillary constriction should prompt an immediate evaluation for acute Horner's syndrome.

Differential diagnosis of causes of pupillary constriction in alphabetical order
In alphabetical order:


 * Adie's pupil (long standing)
 * Argyll Robertson Pupils
 * Anisocoria
 * Coma
 * Horner's Syndrome
 * Iritis
 * Posterior iris synechiae
 * Systemic opioids
 * Systemic cholinergics
 * Tertiary Syphillis
 * Topical cholinergics

History and Symptoms

 * Specific medicinal and surgical history
 * attention to neurologic, opthalmologic and otolaryngologic

Eyes

 * Pupil size in light and dark
 * Pupil response to light and convergence
 * lid position

Laboratory Findings

 * Labs include
 * Rapid plasma reagin
 * VDRL
 * FTA-ABS

MRI and CT

 * Chest CT if Horner's syndrome is found & to rule out apical lung mass
 * MRI of head and neck if necessary

Other Imaging Findings

 * Carotid Doppler
 * Carotid Angiogram

Acute Pharmacotherapies

 * Administer high dose IV penicillin for syphillis

Primary Prevention

 * Remove problem causing medications