How to test for accommodation reflex?
The patient is first allowed to look at a distant object and then ask him to look at your finger suddenly which is placed near his nose (eg, at 10 cm from the eyes). The responses are, 1) Miosis (bilateral) 2) Medial convergence of the eyeball 3) Increased anterior convexity of lens (not clinically evident) 4) Enophthalmos (not clinically evident) Afferent pathway – optic nerve, efferent pathway – oculomotor nerve, centre oculomotor nuclei at midbrain. Identification Points : In the presence of ptosis : 1) Miosis indicates Horner’s syndrome and mydriasis indicates oculomotor palsy. Ptosis due to Horner’s syndrome is usually partial. 2) Lateral squint with complete ptosis indicates oculomotor palsy. 3) Wrinkling of the forehead points towards tabes dorsalis (tabetic facies) through it may be present in any patient with ptosis. 4) Abnormal fatiguability of muscles after repeated use indicates myasthenia gravis. 5) Facies characterized by ‘hatchet face’ with ‘swan-neck’, frontal baldness,
