Why cataracts do not produce afferent pupillary defects.
Explore the source record for details and available documents.
Afferent Pathways↗
SEARCH · Search PubMed
Results for “Pupil Disorders”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Relative afferent pupillary defects in patients with Leber hereditary optic neuropathy and unilateral visual loss.
PURPOSE: It has been suggested that the pupillary light reaction is relatively preserved in the affected eyes of patients with Leber hereditary optic neuropathy (LHON). To test the hypothesis that visual-pupillomotor dissociation exists in LHON, we performed a retrospective study to evaluate the magnitude of the relative afferent pupillary defect (RAPD) in patients who had experienced monocular visual loss. We also compared the size of the measured RAPD with the size of the RAPD that would be expected on the basis of documented visual field loss. METHODS: We identified a cohort of patients with LHON and monocular visual loss, whose pupillary reactions had been quantified using neutral density filters. From a review of the case records, we determined whether an RAPD was present, as well as the magnitude of the documented RAPDs. We also calculated the expected size of the RAPD for each patient, using previously established templates that correlated the size of the RAPD with the degree of visual field loss. RESULTS: An RAPD was identified in all 10 patients in this study. There was no significant difference between the size of the measured and predicted RAPD, nor did the size of the RAPD correlate with visual acuity or the time interval between the onset of visual loss and evaluation. CONCLUSION: The results of this study do not support the hypothesis that visual-pupillomotor dissociation is a common feature of LHON.
Adolescent↗
Ultrasound biomicroscopic quantitative analysis of light-dark changes associated with pupillary block.
PURPOSE: To quantitatively analyze the changes in anterior chamber angle and iris configuration induced by varying illumination in patients with narrow angles and pupillary block. METHODS: Twenty-four eyes of 24 patients with pupillary block (mean age, 52.5 years) had ultrasound biomicroscopic images of the angle and iris structures obtained superiorly, nasally, inferiorly, and temporally. Images were performed in the light and the dark. We measured the angle opening distance, iris thickness, iris chord length, iris-lens touch, and iris curvature. RESULTS: Changes in iris and angle configuration occurred within a few seconds of a change in lighting. The mean dark measurements were statistically significantly less than the mean light measurements for angle opening distance (96 +/- 18 vs 185 +/- 26 microm, P = .0001), iris chord length (2,505 +/- 61 vs 3,001 +/- 69 microm, P = .0001), and iris-lens touch (350 +/- 20 vs 693 +/- 35 microm, P = .0001). The mean dark measurements were statistically significantly greater than the mean light measurements for iris thickness at 500 microm from the scleral spur (367 +/- 10 vs 307 +/- 25 microm, P = .0001), and 1,500 microm from the scleral spur (404 +/- 14 vs 347 +/- 12 microm, P = .0001). Iris curvature in all four quadrants was statistically significantly greater in the dark than the light. CONCLUSIONS: This study quantitatively confirms that angle narrowing in the dark in eyes with pupillary block is associated with iris shortening, increased iris thickness, and increased iris convexity. Iris-lens touch is relatively small in pupillary block and decreases with dilation. Angle narrowing with dilation is not related to increased iris-lens touch and occurs promptly without requiring time for aqueous pressure buildup behind the iris.
Adult↗
Tissue plasminogen activator to treat impending pupillary block glaucoma in patients with acute fibrinous HLA-B27 positive iridocyclitis.
PURPOSE: To report the use of intracameral tissue plasminogen activator to dissolve fibrinous membranes and break posterior synechiae in patients with acute HLA-B27-positive iridocyclitis with impending pupillary block. METHODS: Two patients with severe acute fibrinous iridocyclitis and seclusio pupillae were identified. Because of the concern of impending pupillary block, intracameral tissue plasminogen activator (12.5 microg in 0.1 ml, Activase; Genentech, Inc, South San Francisco, California) was injected with a 25-gauge needle through the corneal limbus. RESULTS: Both patients showed complete dissolution of fibrin with disruption of posterior synechiae. There were no adverse events after injection. Neither patient required further invasive intervention, and both fully recovered with medical management. CONCLUSIONS: Intracameral tissue plasminogen activator is a safe and effective agent for patients with severe acute iridocyclitis and pupillary seclusion. Patients with clinical signs suggestive of impending pupillary block glaucoma may be considered for tissue plasminogen activator injection to avoid the possible need for emergency surgical iridectomy and synechiolysis.
Acute Disease↗
Optic tract syndrome secondary to metastatic breast cancer.
PURPOSE: To report a patient who was initially examined with optic tract syndrome caused by a focal metastasis to the lateral geniculate body and optic tract. METHOD: Case report. RESULTS: A 44-year-old woman with metastatic breast cancer was initially examined with normal central visual acuity, afferent pupillary defect, homonymous hemianopia, and optic atrophy. CONCLUSION: This case demonstrates that an isolated optic tract syndrome may occur as a result of metastatic lesions to the lateral geniculate body and optic tract.
Adult↗
Tract hemianopia resulting from traumatic distal internal carotid artery dissection.
Explore the source record for details and available documents.
Accidents, Traffic↗
Congenital fibrosis of the extraocular muscles with brain-stem abnormalities: a novel finding.
Explore the source record for details and available documents.
Abnormalities, Multiple↗
Pupillography of relative afferent pupillary defect contralateral to monocular mature cataract.
CASE REPORT: Few previous reports have documented a relative afferent pupillary defect (RAPD) in the eye contralateral to a dense unilateral cataract. We report pupillographic findings of a 55-year-old man with a mature cataract in the left eye and an RAPD in the right eye, whose RAPD disappeared after cataract surgery in his left eye. Using binocular infrared video pupillography, we recorded the pupillary responses of the two eyes simultaneously during an automated swinging flashlight test before and after the cataract surgery. The average contraction amplitude in both eyes was significantly larger when the unaffected left eye was stimulated before the cataract surgery, but this difference in contraction amplitude disappeared after surgery on the left eye. COMMENTS: An RAPD was shown quantitatively with a pupillographic technique in the eye contralateral to a mature cataract, confirming previous studies that indicate a dense cataract may produce a small but definite RAPD in the contralateral eye. Such an RAPD associated with a dense cataract must be taken into consideration when evaluating patients with unilateral visual loss.
Cataract↗
An unusual junctional scotoma.
A 28-year-old woman presented with painful unilateral left visual loss, impaired color vision, left afferent pupillary defect, and normal ocular fundus. Although optic neuritis was first suspected, visual fields disclosed a junctional scotoma related to chiasmal demyelination, due to a probable multiple sclerosis.
Adult↗
Hyoscine cycloplegia in children.
Explore the source record for details and available documents.
Accommodation, Ocular↗
Unexpected corneal endothelial cell decompensation after intraocular surgery with instruments sterilized by plasma gas.
PURPOSE: Ten cases of unexpected corneal endothelial cell decompensation occurring after routine intraocular surgery using instruments sterilized with a new plasma gas protocol are described. DESIGN: A retrospective observational case series with 1 year of follow-up was conducted. RESULTS: All patients had corneal decompensation and nonreactive pupils after surgery. Six patients required penetrating keratoplasty. Three patients partially recovered pupillary function. Visual acuity at 1 year ranged from 20/20 to hand motion (HM). One patient with an anterior chamber intraocular lens (ACIOL) experienced optic atrophy and HM vision despite resolution of corneal edema. CONCLUSIONS: Toxic corneal endothelial cell destruction syndrome was associated with the introduction of plasma gas sterilization protocols.
Adult↗
Portable pupillography of the swinging flashlight test to detect afferent pupillary defects.
OBJECTIVE: To investigate the ability of a portable, personal computer-driven, pupillometer to record the pupillary response curve during the swinging flashlight test. Also, to determine whether these response curves can be used to identify and quantify relative asymmetry in the pupillary light reflex between eyes in healthy volunteers with simulated afferent pupil defects (APDs) and patients with optic neuropathies. DESIGN: Comparative, observational case series and instrument validation. PARTICIPANTS: Healthy volunteers with no known ocular disease and patients (n = 20) with various optic neuropathies noted to have relative APDs on examination. METHODS: Pupillary response curves of the right eye were recorded with a portable, electronic, infrared pupillometer from healthy volunteers (with and without simulated APDs) and patients with APDs while the light stimulus alternated between eyes, simulating the swinging flashlight test. Simulated APDs in healthy volunteers were created with increasingly dense neutral density filters in front of the left eye. MAIN OUTCOME MEASURES: Differences in constriction amplitude, latency, and constriction velocity of the pupillary response with right eye stimulation versus left eye stimulation in both groups of subjects. RESULTS: A significant correlation between neutral density filter strength and intereye differences was seen for all measurement parameters in volunteers with simulated APDs. Depending on the measurement parameter and stimulus intensity, simulated APDs of 0.6 log units or more could be distinguished from normal responses. Clinically graded true APDs had intereye differences similar to simulated APDs of the same density. Those with real and simulated APDs of 0.9 log units or more could be distinguished from healthy volunteers with 80% sensitivity and 92% specificity. Responses from those with real and simulated small APDs of 0.3 to 0.6 log units could not be distinguished reliably. CONCLUSIONS: Portable, personal-computer driven, electronic, infrared pupillography can record the swinging flashlight test accurately and identify large afferent pupillary defects. An affordable, portable, reliable device for identifying relative APDs would be useful in the identification and follow-up of patients with neurogenic vision loss.
Adult↗
Laser in situ keratomileusis-induced optic neuropathy.
OBJECTIVE: To report a case of bilateral optic neuropathy after bilateral laser-assisted in situ keratomileusis (LASIK) surgery. DESIGN: Observational case report. METHODS: Complete eye examination with detailed evaluation of the optic nerve, detailed medical history, stereo disc photographs, GDx Nerve Fiber Analyzer testing, Humphrey 24-2 SITA visual field testing, diurnal intraocular pressure measurement, serologic evaluation, and magnetic resonance imaging of the brain and orbits. MAIN OUTCOME MEASURES: Optic nerve status, visual field status, and visual acuity. RESULTS: A subject with previously healthy optic nerves had bilateral optic neuropathy develop after LASIK surgery. This neuropathy manifested with a subjective decrease in visual field, normal visual acuity, normal color vision, relative afferent pupillary defect, increased cupping of the optic nerve with focal neuroretinal rim defects, decreased nerve fiber layer thickness, and nerve fiber bundle-type visual field defects. The subject had no other risk factors for optic neuropathy. No other cause of neuropathy was identified. CONCLUSIONS: Optic neuropathy is a potential vision-threatening complication of LASIK surgery. This complication may be due to barotrauma or ischemia related to extreme elevation of intraocular pressure by the suction ring. Careful examination of the optic nerve before and after LASIK surgery is warranted.
Adult↗
Purtscher-like retinopathy after retrobulbar anesthesia.
A Purtscher-like retinopathy occurred in a 41-year-old woman who underwent the excision of a pterygium after a retrobulbar injection of 3 ml of lidocaine HCl. Visual acuity increased from 20/200 on the first postoperative day to 20/25, 12 weeks later. The exudates and the hemorrhages progressively disappeared. However, a relative, localized, paracentral scotoma and an afferent pupil defect still persist. The pathophysiology of this Purtscher-like retinopathy is discussed.
Anesthesia, Local↗
A unilateral cataract produces a relative afferent pupillary defect in the contralateral eye.
The relative afferent pupillary defect (RAPD) was measured with neutral density filters in ten patients, each of whom had a dense cataract in one eye only. In each instance, the cataract reduced visual acuity to counting fingers or worse, whereas visual acuity in the other eye was 20/25 or better. All patients with mature or nuclear cataracts had a measureable RAPD in the other eye (mean, 0.44 log unit). In each instance, after extraction of the cataract, the RAPD disappeared. Thus, a dense cataract causes an RAPD in the contralateral eye by increasing the pupillomotor effectiveness of the stimulus light and that this is the reason why even a brunescent cataract does not cause an RAPD in the same eye. In addition, two clinical cases are reported. One case records the development of a cataract in an eye with a preexisting RAPD resulting from optic neuritis; as the cataract became more opaque, the afferent defect became smaller and finally was reversed. The other case shows that a traumatic cataract can produce an RAPD in the contralateral eye. Thus, when an afferent pupillary defect is seen in an eye with a cataract, a visual pathway defect in that eye should definitely be suspected.
Adult↗
Long-term efficacy of orbital decompression for compressive optic neuropathy of Graves' eye disease.
In a retrospective evaluation of the long-term effect of transantral-ethmoidal decompression for compressive optic neuropathy, the authors evaluated visual acuity, visual fields, color vision, and motility in 30 patients (52 orbits) for a median follow-up period of 2.5 years (range, 0.6 to 6.5 years). Patients with preoperative visual acuity of 20/40 or better uniformly remained in this category and demonstrated an earlier stabilization of vision than those with poorer preoperative visual acuity. Of the ten patients whose preoperative visual acuity was 20/50 to 20/100, 80% attained acuity of 20/40 or better. In patients whose visual acuity was 20/200 or less (n = 7), 57% attained an acuity of 20/40 or better. The most common visual field defect was generalized constriction, which was noted in 43 of the 52 eyes (83%). After decompression, the preoperative visual field defect had improved or completely resolved in all but one case. Dyschromatopsia, noted in 20 eyes preoperatively, cleared in 17 (85%) postoperatively. Although the study showed that surgical decompression is beneficial, some patients may require additional modalities of treatment.
Adult↗
Acquired heterochromia with horner syndrome in two adults.
BACKGROUND: Heterochromia iridis, asymmetry of iris pigmentation, has been well described with congenital Horner syndrome. Acquired heterochromia associated with lesions in the ocular sympathetic pathways in adulthood, however, is rare. METHODS: Two cases are reported in which sympathectomy in adults resulted in ipsilateral Horner syndrome with heterochromia. In each case, pharmacologic testing with cocaine and hydroxyamphetamine was performed. RESULTS: In both cases, sympathectomy occurred at the level of the second order neuron, but hydroxyamphetamine testing suggested at least partial third order neuron involvement. CONCLUSION: Acquired heterochromia can occur in adults. The partial response to hydroxyamphetamine in the two cases presented may reflect trans-synaptic degeneration of the postganglionic neuron. A reduction in trophic influences on iris melanocytes may have contributed to the observed heterochromia.
Aged↗