Pupillary Reflexes and Pathologies

A 52-year-old man presents with acute onset of severe eye pain, blurred vision, and a fixed, mid-dilated pupil. Anterior chamber examination shows corneal edema and elevated intraocular pressure (68 mmHg). Gonioscopy reveals angle closure. What is the drug of choice for immediate management of the acute attack?

A 28-year-old woman presents with a right-sided Horner syndrome. On examination, the right pupil is 3 mm and the left is 4 mm in dim light. Both pupils react normally to light and accommodation. Which finding best distinguishes preganglionic Horner syndrome from postganglionic Horner syndrome in this patient?

A 28-year-old woman presents with progressive bilateral pupillary constriction over 6 months, with preserved light and accommodation reflexes. She reports no vision loss or ocular pain. Slit-lamp examination reveals no iris atrophy, transillumination defects, or anterior chamber inflammation. Systemic examination is unremarkable. Which investigation is most appropriate to evaluate the underlying cause of this bilateral pupillary miosis?

A 35-year-old woman presents with a dilated pupil on the left that reacts sluggishly to light but shows brisk constriction on accommodation (light-near dissociation). There is no ptosis or ophthalmoplegia. Deep tendon reflexes are diminished. What is the most common cause of this pupillary abnormality?

A 35-year-old man presents with a dilated pupil on the right side that does not react to light but constricts on accommodation. On the left side, the pupil is normal. Which finding best distinguishes Adie's tonic pupil from third nerve palsy affecting the right eye?