Approach to the Critical Patient

Immediate priorities

Dangerous mimics first

Benign branch recognition

Key Concepts

Core principle

Triage decision points

PITFALLS

Common errors

History

Onset and presenting symptoms

Discovery pattern

Visual complaints

Key historical elements

Precipitating context

Medication and exposure review

Alarm features

Red flags mandating urgent workup

Systemic warning patterns

Associated symptoms and negatives

Important negatives in classic Adie's

Risk factors

Demographic and host factors

Infectious and paraneoplastic associations

Family and collateral history

Collateral clues

Family history

Physical Exam

Pupillary examination

Pupil size and shape

Light and near responses

Slit lamp and ocular exam

Slit lamp findings

Motility and lid assessment

Neurologic and systemic exam

Deep tendon reflexes

Autonomic assessment

PITFALLS

Examination errors

Differential Diagnosis

Dangerous diagnoses

Life and vision threats

Benign and pharmacologic mimics

Pupillary mimics

Dissociation and small-pupil mimics

Systemic syndromic associations

Bilateral tonic pupil contexts

Laboratory Tests

Targeted workup for atypical cases

When labs are indicated

Infectious screen

Systemic and autoimmune panels

Metabolic and inflammatory

Autoimmune and neuropathic

Paraneoplastic evaluation

Diagnostic Tests

Scoring Systems

Pharmacologic diagnostic testing

Bedside clinical assessment

MRI

MRI brain indications

CT

CT and CTA indications

Ultrasound

Ocular and adjunct ultrasound

Disposition

Discharge pathway

Safe discharge criteria

Outpatient referral

Admission and urgent workup

Mandatory escalation triggers

Treatment

Reassurance and symptomatic care

Idiopathic Holmes-Adie management

Pharmacologic symptom control

Topical pilocarpine therapy

Treatment of secondary causes

Underlying etiology management

What to avoid

Special Populations

Pregnancy

Pregnancy considerations

Geriatric

Older adult features

Pediatrics

Pediatric considerations

Background

Epidemiology

Frequency and demographics

Pathophysiology

Mechanism of tonic pupil

Therapeutic Considerations

Management principles

Evidence base

Patient Discharge Instructions

copy discharge instructions

Your diagnosis

Home care

What to expect

Return to the ER immediately if

Follow up

References

Guidelines and key sources

Review and diagnostic sources

Neuro-ophthalmology references

Syndromic associations

Coding standards

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.