Narrowed pupils

A huge diagnostic role in certain diseases is played by the diameter of the pupils, their ability to narrow or expand, adapt to various lighting options. Narrowed pupils are a frequent symptom of uremia, tumors, inflammatory reactions and intracranial hemorrhages, various poisonings and intoxications. When the cervical sympathetic knot is squeezed, narrowing will be found on the side of the lesion.

What else can speak a symptom of narrowed pupils? The reasons for this state can be many, and it is this question that we will try to disclose in our article.

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Causes of narrowed pupils

The true narrowing of the pupils is called pronounced decrease (less than 2.5 mm in diameter). This phenomenon is not always accepted as pathology. For example, physiological narrowing in old age, in newborn children, after considerable physical and mental loads, with a focus on different distances, etc., can be considered a variant of the norm. The simplest way to cause a pupil narrowing is to provoke a physiological reflex reaction that occurs when getting into area of the eye is a beam of high brightness light.

Also, the narrowness of the pupil appears in patients suffering from hyperopia, during sleep.

Drug contraction of the pupils appears when taking certain medications:

• the agents oppressing activity of adrenoblockers;
• m-cholinomimetic agents (Pilocarpine, Muscarin);
• holinostimulating preparations;
• cardiac glycosides;
• hypnotics;
• reserpine, opium preparations;
• anticholinesterase drugs with holinopotentsiruyuschim action.

The narrowing of the pupil on one eye occurs in people who represent certain professions and use monocles (for example, jewelers or watchmakers) for their professional activities.

[2], [3]

Dilation of pupils as a sign of disease

In medicine, the narrowing of the pupils can be considered as a pathology in the diagnosis of the following diseases:

• when the brain is damaged, especially its posterior part (medulla oblongata, bridge and cerebellum);
• when comatose;
• with increased intracranial pressure;
• with a foreign cornea;
• when the third pair of cranial nerves is affected;
• with diseases of the central nervous system (meningitis, encephalitis, neoplasms in the brain, with multiple sclerosis, epilepsy);
• with diseases of the ciliospinal center, the cervical site of the sympathetic trunk;
• with neurosyphilis.

In addition, narrowing can be observed against the background of an acute form of iritis, with ulcerous lesions of the cornea, inflammation of the choroid of the eye (anterior or posterior), with eyelid drooping, with a hemorrhage into the anterior chamber of the eye.

Toxic narrowing of the pupils is detected by poisoning with substances such as morphine, ethyl alcohol, nicotine, chloral hydrate, coloring preparations, bromine, phosphorus compounds, fungi, caffeine, nerve gas (sarin, soman).

Having consulted with an ophthalmologist, we identified a number of the most common questions asked by patients at a doctor's appointment. All of them to some extent reflect the possible causes of pupillary narrowing, as well as factors affecting the diameter of the pupils. Let's get acquainted with the expert's opinion on the questions posed.

Why can there be narrowed pupils in the child? Should I worry?

• It all depends on the age of the child. In the first year of life the pupil of the baby is physiologically narrowed, there is a sluggish reaction to the light source and a poor expansion of the pupil.

As for the older child, the narrowness of the pupil can be a sign of head trauma, increased intracranial pressure, or poisoning with any substances. Such a condition requires urgent doctor consultation.

In adolescence, a prolonged change in the diameter of the pupil against the background of a general change in behavior and a strange glint in the eyes may indicate a child's involvement in drug addiction. When a teenager returns home, it is necessary to pay attention to his eyes, to evaluate their reaction to lighting, to direct a direct light into his face. If the diameter of the pupil remains unchanged, then there is really a reason for excitement, even if this has nothing to do with drug addiction. Call your doctor and do not hesitate.

If a person has very narrow pupils, what disease can be suspected?

• Severely narrowed pupils are a symptom of a direct pathology of the lower part of the midbrain, secondary compression of the trunk due to a sudden increase in intracranial pressure. This condition can be the result of increasing hematoma or trauma, and also appears in old age in patients suffering from vascular parkinsonism.

In addition, too narrow pupils can be observed with damage to the bridge and the cerebellum, but this condition is usually associated with loss of consciousness.

In the absence of pathology, excessively narrowed pupils are a sign of the use of medications, for example pilocarpine or morphine.

What can be seen constantly narrowed pupils?

• This clinical symptom often accompanies eye diseases, which are characterized by a spasm of the musculature of the iris, for example, irit or iridocyclitis. Because of this, the eyes stop responding to light sources. However, the most frequent cause of permanent constriction is glaucoma - simultaneously with increased intraocular pressure, the outflow of intraocular fluid deteriorates. Reflexive narrowing of the pupil facilitates this outflow.

Of the most serious causes of this condition can be called malignant neoplasms, neurosyphilis and hemorrhagic stroke.

My eyes have narrowed for a few days and my head hurts, the pills do not help, what's wrong with me?

• A constant headache with nausea and a change in the diameter of the pupil may be the main signs of increased intracranial pressure. Diagnosis of the disease and prescribe treatment can only be a doctor during a full-time consultation. The doctor will necessarily conduct an examination of the fundus, in which the edema of the optic nerve is detected, the absence of pulsating movements of the retinal vessels. A significant increase in intracranial pressure may be accompanied by an increase in blood pressure, bradycardia, arrhythmia.

There was nausea, narrowing of the pupil and salivation. What kind of disease are these symptoms?

• These symptoms are most similar to the signs of poisoning with organophosphorus compounds, for example, all known dichlorvos. Dichlorvos are often used to get rid of parasites, uninvited insects, and also to prevent plant diseases. The clinical picture of poisoning can occur for several minutes after the substance has entered the body, but it can develop for 7-8 hours.

The main signs of intoxication are: nausea and the urge to vomit, increased salivation and sweating, a disorder of the stool, a narrowing of the pupil. With severe poisoning, the consequences can be very unfavorable, so when the first symptoms should always consult a doctor.

Can there be a narrowing of the pupils under pressure?

• When hypertension - increasing blood pressure - the pupils, as a rule, expand. However, with a sharp drop in the indices of pressure, the pupils can sharply contract. The same reaction is observed when taking certain drugs, the action of which is aimed at lowering blood pressure. These drugs include, for example, reserpine, which is actively used in the early stages of hypertension.

If the increase in blood pressure is combined with an increase in intracranial pressure, then at the initial stage the pupils can also narrow. In the future, however, they are expanding.

Can there be a narrowing of the pupils when irradiated with X-rays?

• According to the studies, single x-ray irradiation up to 50 P is considered to be practically safe, if it is received no more often than once during four days. The pathological condition after acute irradiation is observed under the influence of significant radiation doses - from 100 P and above. Even with radiation sickness degree I, patients can have general excitement, irritability, pupillary narrowing, mucosal hyperemia, loss of appetite.

In case of receiving a large dose of radiation, it is necessary to consult a radiologist for medical assistance.

The narrowed pupils are not always a sign of the disease. Sometimes it's just a reflex response of the body to changing lighting, accommodation and convergence, to mental and physical overload, etc. But if the pupils contraction continues for a long time, and is accompanied by some other suspicious symptoms, then the doctor's consultation should be mandatory.

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