Questions Your Doctor May Ask - and Why!
During a consultation, your doctor will use various techniques in his assesment of the symptom: Pupil symptoms.
These may include a physical examination or other medical tests.
Your doctor may ask several questions when assessing
your condition. It is important to remember that your consultation is a two-way process and any extra information
you can share with your doctor may help them with their diagnosis.
Some of the questions your doctor may ask are listed below:
- How long have you had the pupil symptoms?
Why: to determine if acute or chronic.
- What pupil symptoms do you have?
Why: e.g. dilated pupil, constricted pupil, pupils of unequal size, pupils of unequal shape, pupil with an irregular shape, pupil that does not react to light, pupil that does not react to focusing from a near object to a far one.
- If pupil is dilated, are both pupils dilated?
Why: Bilateral pupil dilation would most likely suggest drug intoxication such as Phenobarbital, marijuana and PCP. Other possibilities include concussion and glaucoma.
- If pupil is constricted, are both pupils constricted?
Why: bilateral pupil constriction would suggest narcotic intoxication. Unilateral pupil constriction would suggest Horner's syndrome.
- History of head trauma?
Why: concussion or intracranial haematoma (brain blood clot) may cause pupil dilation.
- Past medical history?
Why: e.g. iritis may cause pupil dilation or pupil constriction and may be seen in inflammatory bowel disease, ankylosing spondylitis, Reiter's syndrome, diabetes mellitus and sarcoidosis; Oculomotor nerve palsy (third cranial nerve) lesion may cause pupil dilation and may be caused by brain aneurysm, brain tumor or meningitis; Horner's syndrome may cause a unilateral pupil constriction and may be caused by cancer in the top of the lung, thyroid cancer, trauma to the neck, surgery to the neck, cluster headache, tumor of the brainstem and stroke of the brainstem.
- Medications?
Why: some medications may cause bilateral pupil dilation such as Phenobarbital an agent used for epileptic seizures; narcotics drugs may cause bilateral pupil constriction.
- Illicit drug use?
Why: e.g. marijuana and PCP may cause bilateral pupil dilation; narcotics drugs may cause bilateral pupil constriction.
- Sexual history?
Why: to help determine the risk of neurosyphilis which may cause pupil dilation.
- Family history?
Why: e.g. glaucoma, brain aneurysm, diabetes.
Questions your doctor may ask about related symptoms:
Sometimes, other symptoms may be present and may help your doctor analyse
your condition. These may include:
- Blindness?
Why: Blindness associated with pupil dilation would suggest an optic nerve lesion (second cranial nerve). Impaired vision associated with pupil dilation may also suggest glaucoma or iritis. Blurring of near vision associated with a dilated pupil may suggest Homes-Adie pupil.
- Redness of the eye?
Why: associated with pupil dilation would suggest definite eye disease such as iritis or glaucoma.
- Joint pain?
Why: associated with pupil dilation may suggest iritis due to either ankylosing spondylitis, Reiter's syndrome or inflammatory bowel disease.
- Fever?
Why: may suggest meningitis, encephalitis, brain abscess or brainstem abscess.
- Irregular pupil shape?
Why: may suggest normal genetic variation, iritis, multiple sclerosis, coloboma, previous cataract surgery, neurosyphilis.
- Ptosis of the eyelid (dropping down of the eyelid)?
Why: partial ptosis associated with a constricted pupil would suggest a Horner's syndrome. Complete ptosis with a fixed dilated pupil would suggest a complete oculomotor (third cranial nerve) palsy.
- Symptoms of Horner's syndrome?
Why: e.g. partial ptosis (dropping down of the eyelid), unilateral constricted pupil, decrease of sweating over the involved eyebrow.
» Next page: Types of Pupil symptoms
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