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Pupil Anomalies

pupil anomalies
Taking a set of vitals is standard procedure for all medically trained caregivers and while patients rarely give it a second thought, health professionals love vital signs. The importance of these signs is self-evident to the medical world; they are the clues to a condition, an attribute of life and once in decline, a harbinger of death.

Vitals are not just numbers; they reflect a patient's well-being and show changes in circumstances, often particularly important ones. The eyes may be the windows to the soul, but just the pupils can reveal plenty of information for diagnosis purposes.

The Pupil

The pupil of the eye resembles a black hole that can constrict (close), or dilate (open), in response to various factors. Essentially the role of the pupil is to adapt and change size to allow the maximum amount of light into the retina without causing damage. The retina converts the light into nerve impulses which travel to the optic nerve and then directly to the brain, allowing a person to see.

Pupils have an involuntary reflex but they can and do react to emotional states. Pupil sizes can portray the following emotions:
  • fear
  • hostility
  • sympathy
  • love

Pupil Changes Caused By Medical Conditions

Medical caregivers examine pupil size because they can be directly correlated to health conditions. In this case, it isn’t only the size of the pupils that are noted but their reactivity and equality too. In normal circumstances, pupils should be neither large nor small, but average. If extra light is supplied, both pupils should constrict and if surroundings become darker, both pupils should dilate, equally. What happens in one eye should also happen in the other, giving a bilateral reaction.

Drugs are by no means the single factor of pupil change, but depending on the type of drug involved they can cause pupils to constrict, dilate, or show a lack of reactivity. Drugs are often the first suspect in any pupil changes where there has been no trauma and no history of an existing illness.

Pupil Appearance

Significant or possible causes of constricted pupils include:
  • drugs such as Heroin, Fentanyl, Codeine, Tramadol and other narcotics
  • migraine
  • corneal ulcer
  • Horner Syndrome (damage to the sympathetic nervous system serving the eyes)
  • pancoast tumor (carcinoma of the lung apex)
  • uveitis (inflammation of the inner eye)
  • prescription eye drops
Significant or possible causes of dilated pupils include:
  • adrenaline
  • drugs such as antipsychotic agents, atropine, cocaine
  • blood loss
  • OTC and prescription eye drops
  • Seratonin Syndrome (a toxic reaction to serotonin)
Significant or possible causes of unequal pupils include:
  • stroke
  • head injury
  • artificial eye
  • eye Injury
  • Adie’s Syndrome (light response slower in one eye possibly due to a mechanism malfunction)
  • third cranial nerve palsy
  • tumor
  • meningitis
  • encephalitis
Significant or possible causes for lack of reactivity in pupils include:
  • drugs
  • lack of oxygen to the brain
  • brainstem coma
  • death
Pupil Facts and considerations:
  • Most of the light entering the eye does not escape, which is why the pupil appears black.
  • It takes longer for a pupil to dilate than constrict.
  • Pupils can miss the mark immediately; they will shrink down and then reopen slightly.
  • If both pupils are dilated, it is usually due to drugs, not disease.
  • Red eyes are the result of the camera flash bouncing off the retina, back out of the eye and into the camera lens.
  • Emergency medical responders carry pupil gauges to measure pupil size.
  • Pupils that are fixed and dilated typically indicate impending death.

Baseline Pupil Sizes

As with any vital sign, a baseline should always be taken for comparison purposes. When checking the pupils, note the size before shining a light into them. Do one eye at a time covering the opposite eye with your hand. When the light hits the pupil it should constrict and when the light is removed, it should dilate back to its normal position.

While the pupil size, reactivity and equality will not specifically diagnose a condition, it can offer tremendous clues for health professionals in the pursuit of a diagnosis.

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Controversial Drugs Serve Double Duty

controversial drugs

Medications have been a part of life since time began. There are some safe natural medications to be taken and some not so safe, highly controversial drugs being prescribed. Now, these same health risk drugs are being prescribed to help cure other health problems. Below are some of the top medications, used for double duty, that doctors are giving their patients.

Finasteride or Propecia May Cause Cancer

Finasteride, also known as Propecia, is a hair-loss drug. The American Society of Clinical Oncology and the American Urological Association are recommending that the millions of men, age 55 and older, ask their doctor about finasteride. In recent studies, taking this drug has shown that it wards off prostate cancer. In a study of 18,000 men done in 2003, finasteride cut the risk of prostate cancer by 8 percent.

The down side to this drug is that it will cost an average of $90 per month. Not only that, the use of this drug may lead to high-grade cancers. While the proponents have denied these findings, many doctors have voiced their concern over the use of finasteride. Dr. Aaron Katz, director of the center for Hostistic Urology at Columbia University, and Robert Getzenberg, director of Urology Research at the Brady Urology Institute at Johns Hopkins Hospital both agree that this drug may be potentially dangerous, and its use leaves too many unanswered questions.

Phosphatidylcholine May be Unsafe to Use Cosmetically

Phosphatidylcholine is a soybean based, FDA approved treatment for breaking down fat in the blood. Its other names include lipostabil and lipodissolve as a surgery-free fat buster. ABC News interviewed Dr. Malcolm Roth, director of plastic surgery at Maimondes Medical Center in Brooklyn, N.Y. In a report to ABC News, he said that there is no real scientific study showing that phosphatidylcholine definitely works. He wonders about the chemicals and if they are safe when injected into fat.

Despite the dangers of this procedure, the number of clinics offering this treatment is growing. Many of the physicians performing this procedure lack the training in liposuction, plastic surgery or dermatologic surgery. Startling enough, even dentists are using it. Cosmetic surgeons and dermatologists agree that people just wanting a slimmer look should avoid these injections. Brazil and other countries have banned its use for cosmetic purposes.

Ecstasy Used in Medical Studies

In 1985, the use of Ecstasy became an illegal substance in the United States, but researchers hope that one day it can be used to treat post-traumatic stress disorder. They are thinking it will be especially useful for the returning veterans. A group of psychiatrists discovered that Ecstasy affects the level of serotonin.

Serotonin is a brain chemical that regulates the mood and is effective used as a therapeutic tool. In 2004, the U. S. government authorized a human study, even though it is still illegal to use, but they have hopes that it can help heal those suffering from emotional scars, or traumatic events that have happened to them.
Today, Ecstasy remains on the government’s list of Schedule 1 drugs. This classification also includes heroin, cocaine and methamphetamines. Researchers and others are still hopeful that the restrictions will be lifted so it can help the returning solders.

Thalidomide Causes Birth Defects

Thalidomide is a very controversial drug. It was first used in 1957 to help ward off morning sickness that pregnant women experience. While it helped in the morning sickness, it had severe side effects. Babies were born with severe birth defects, such as cleft palates, missing or abnormal limbs, spinal cord deformities and organ abnormalities.

A very small group of people benefited from this drug. It helped those that had erythematic nodosum leprous (ENL). This is a severe and debilitating leprosy-associated complication. Although the World Health Organization is against the use of this drug, in 1998 the FDA cleared this drug to be used for leprosy. Since it has big risks to unborn babies, the use of this drug is under strict supervision. Women must undergo pregnancy testing before and during their treatment. Men are required to use a condom whenever they have sex. All patients receive a 28-day supply and must see their doctor before they get any more refills of this drug.

The list of these drugs is only a partial one. As in all things, before considering any kind of medication know the risks involved. Do those side effects outweigh the problem? Can a safer solution be found? Talk to your doctor and make an informed decision.

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