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Pupillary constriction occurs following administration of opioids and may be used as a marker of opioid activity. We have measured plasma concentrations and pupil diameters in 16 healthy volunteers after the oral administration of placebo or codeine. Pupil size decreased significantly after codeine compared with placebo. Pupil size was related to the plasma concentrations of codeine (P less than 0.05).
Pupil diameter is used during anaesthesia to assess depth of anaesthesia and indicate cerebral hypoxia. This is especially so during cardiac bypass when other autonomic signs cannot be monitored. We have used a pupillometer to determine the effect of cardiopulmonary bypass on the pupil. We have also investigated if any effect was caused by washout of opioid from the central nervous system by allocating patients to one of two groups: in one the bypass pump was preloaded with fentanyl, in the other with 0.9% saline. Cardiopulmonary bypass caused pupil dilatation of between 17% and 53%, which was unaffected by preloading the bypass pump with fentanyl. This effect lasted for the duration of the study, which ended 30 min after the start of cardiopulmonary bypass. Sympathetic nervous system reflexes and hypothermia may account for this observation, but further research is necessary to exclude other contributory factors.
The mydriatic response to dilute tropicamide was studied in 25 Japanese patients with Alzheimer's disease (AD), 13 patients with non-AD neurological diseases (non-AD) and 11 normal elderly subjects (control). Although the changes in resting pupil diameter and area over baseline were significantly greater (p < 0.05) in AD patients than in non-AD patients and controls, there was considerable overlap between the three groups. The change in resting pupil area was significantly greater (p < 0.05) in AD patients homozygous for ApoE epsilon 4 than in AD patients heterozygous for or without this allele. Despite a limited sample size in the present study, our results indicate that the pupil dilation assay by tropicamide is not an effective diagnostic tool for AD, and it may be modulated by different gene dosage of ApoE epsilon 4.
OBJECTIVE: It has been suggested that driving a car is relatively safe when the driver is treated with nonsteroid anti-inflammatory drugs than when he or she is treated with opioid analgesics. However, the evidence for this statement is scarce. The objective of this study was to determine the effects of a nonsteroid anti-inflammatory drug (bromfenac 25 mg and 50 mg) and an opioid (oxycodone/paracetamol 5/325 mg and 10/650 mg), and placebo on driving ability, memory functioning, psychomotor performance, pupil size, and mood. METHODS: Out of 30 healthy volunteers, 18 completed this randomized, double-blind, placebo-controlled crossover study, before the study had to be stopped due to bromfenac being pulled out from the market. One hour after administration of the drugs, the participants performed a standardized driving test during normal traffic. Thereafter, driving quality, mental effort and mental activation during driving were assessed. A laboratory test battery was performed 2.5 hours after administration of the drug. Visual analog scales assessing mood and pupil measurements were performed on several occasions during each test day. RESULTS: Both analgesics did not significantly affect performance in any test. However, volunteers reported that significantly more effort was needed to perform the driving test when treated with oxycodone/paracetamol, and that they experienced increased sedation and reduced alertness. Also, the pupil size was significantly decreased. In contrast, subjective assessments after both doses of bromfenac matched that of placebo. DISCUSSION: No significant impairment in behavior was found in the volunteers for both bromfenac and oxycodone/paracetamol. The lack of impairment from oxycodone/paracetamol may have been related to the participants reporting increased effort during driving while under the influence of this drug.
The findings of an investigational study comparing a hand held tongue depressor pupil gauge with a printed millimeter scale sheet are the focus of this article. A historical perspective of the development of various millimeter measurement scales and devices is included as well as a brief overview of the anatomy and physiology of the oculomotor (III) cranial nerve. The results of the study provide support for the use of millimeter scales as an effective means of measurement of pupil size. Increased reliability with the use of a hand held tongue depressor pupil gauge is demonstrated. Implications for nursing practice are summarized.
This paper presents a general theory for the remote estimation of the point-of-gaze (POG) from the coordinates of the centers of the pupil and corneal reflections. Corneal reflections are produced by light sources that illuminate the eye and the centers of the pupil and corneal reflections are estimated in video images from one or more cameras. The general theory covers the full range of possible system configurations. Using one camera and one light source, the POG can be estimated only if the head is completely stationary. Using one camera and multiple light sources, the POG can be estimated with free head movements, following the completion of a multiple-point calibration procedure. When multiple cameras and multiple light sources are used, the POG can be estimated following a simple one-point calibration procedure. Experimental and simulation results suggest that the main sources of gaze estimation errors are the discrepancy between the shape of real corneas and the spherical corneal shape assumed in the general theory, and the noise in the estimation of the centers of the pupil and corneal reflections. A detailed example of a system that uses the general theory to estimate the POG on a computer screen is presented.
1. Intravenous heroin was administered to volunteers, in doses of 2.5 and 5 mg to non-dependent subjects and does of 1/6, 1/3 and 1/2 of their prescribed daily does of opiates to dependent subjects, and pupillary responses measured before and three times during the 2 h after injection. 2. Tolerance to the miotic effects of heroin in the dependent subjects was demonstrated--larger doses of heroin were needed to produce the same pupil response in dependent subjects than in non-dependent subjects and the duration of action was shorter in the former group. 3. The effect of concurrent oral methadone medication on pupil response to heroin was demonstrated. Subjects prescribed both methadone and heroin showed smaller control pupil diameters and a reduced dose effect to heroin than did subjects prescribed heroin alone.
OBJECTIVE: To determine whether the combination multiple-dose dorzolamide-timolol administered topically has any greater effects on the reduction of intraocular pressure, pupil size, and heart rate in dogs with glaucoma than do either timolol or dorzolamide alone. PROCEDURE: Applanation tonometry, pupil size, and heart rate measurements were made at 7 a.m., 1 p.m., and 7 p.m. daily of 12 laboratory Beagles with inherited primary open-angle glaucoma during each active phase of this study. Timolol 0.5% was administered first twice daily for 4 consecutive days. Dorzolamide 2.0% was administered next three times daily for 4 consecutive days. The fixed combination of the two (timolol 0.5% and dorzolamide 2.0%) was administered twice daily for 4 consecutive days during the final week of the study. Between administration of each drug, a withdrawal period of at least 10 days was instituted. Statistical comparisons between the effects of the three drugs were performed. RESULTS: Intraocular pressure (IOP) was decreased with the administration of all three drugs: timolol alone, dorzolamide alone, and the combination of the two decreased IOP after 1 day of treatment 2.83 +/- 0.70 mmHg, 6.47 +/- 0.32 mmHg, and 6.56 +/- 0.37 mmHg, respectively. After 4 days of treatment, the IOP decreased even further: timolol alone, dorzolamide alone, and the combination of the two decreased IOP 3.75 +/- 0.88 mmHg, 7.50 +/- 0.29 mmHg, and 8.42 +/- 0.58 mmHg, respectively. Heart rate was significantly decreased with timolol (-11.9 +/- 2.0 bpm) and the combination preparation (-8.6 + 2.4 bpm), but not with dorzolamide (-3.7 +/- 1.8 bpm) alone. Pupil size was significantly decreased with timolol (-1.42 + 0.40 mm) and the combination preparation (-1.3 + 0.33 mm), but not with dorzolamide (0.97 +/- 0.36 mm) alone. CONCLUSIONS: The combination dorzolamide-timolol appears to be more effective at reducing intraocular pressure in glaucomatous dogs than is either timolol or dorzolamide alone.
Lighting plays a major role in contrast sensitivity (CS) measurements. Both the test and surround illumination influence the results although they are not usually considered in clinical practice. The effects of test luminance are well known, but the influence of surround luminance seems to be less investigated. This study aims to evaluate the differences in CS measured with two configurations of surround illumination typical of clinical practice; and to analyse the influence of the angular size of the target on pupil diameter for both surround luminances. An experimental arrangement was designed to measure CS with controlled illumination of both test and surround. An infrared pupillometer was also used to measure steady pupil size. A statistically significant increase of CS and a decrease of pupil size with higher surround illumination were found.
PURPOSE: Constriction of the pupil during phacoemulsification and intraocular lens (IOL) implantation in patients with diabetes mellitus was studied. METHODS: Before surgery a combination of 0.75% cyclopentolate and 2.5% phenylephrine was applied topically to the eyes of 32 patients with diabetes mellitus and 25 age-matched controls. Epinephrine was mixed with buffered saline solution and used during the surgery. The surgical procedure included capsulorhexis, phacoemulsification in the posterior chamber and implantation into the capsular bag of a heparine surface-modified poly(methyl metacrylate) IOL with an optic diameter of 5.0 mm. The durations of phacoemulsification and the whole surgical procedure were recorded. Measurements of the horizontal pupillary diameter were taken before surgery, after phacoemulsification and at the end of the surgery. RESULTS: There was no significant difference in pupil size between controls and the diabetic group before the operation. Surgically induced miosis after phacoemulsification and at the end of operation were significantly more pronounced in the diabetic group than in controls (p < 0.05) (p < 0.05). Phacoemulsification and the entire surgical procedure took significantly longer time when performed in the diabetic eyes (p < 0.05) (p < 0.05). CONCLUSION: We conclude from these data that constriction of the pupil during cataract surgery is more pronounced in diabetic eyes as compared to controls.
Fifty-six patients who underwent extracapsular cataract surgery were randomized in two groups with 28 patients in each group. Group 1 was treated with standard preoperative dilation regime and group 2 received in addition indomethacin 1% ophthalmic solution. Horizontal and vertical pupil diameter measurements were taken before capsulotomy, before exprimation of the lens nucleus and before lens implantation. The size of the pupil at the time of capsulotomy and at the time just before lens exprimation was greatest in the non-indomethacin treated group, but at the time of lens implantation the pupil of the indomethacin treated group was greatest. It is concluded that even though indomethacin seems to be able to inhibit surgically induced miosis, probably through its inhibitory effect on prostaglandin synthesis, the effect is only marginal and from a clinical point of view it cannot be recommended.
The horizontal diameter of the pupil was measured on 20 eyes with exfoliation syndrome and 20 control eyes before and after the instillation of 10% phenylephrine and 4% pilocarpine eye drops. Pupil dilation induced by topical application of the alpha 1 adrenoceptor agonist phenylephrine was significantly smaller in eyes with exfoliation syndrome compared to controls. The cholinergic agonist pilocarpine decreased pupil diameter and this effect was significantly less in cases with exfoliation syndrome. We conclude from these data that the pharmacological response to both adrenergic and cholinergic stimulation is weaker in eyes with exfoliation syndrome compared to controls.
The consensual response of the pupil in the cat was driven by means of a light flux impinging on the contralateral retina. Spike trains recorded extracellularly from single units in the midbrain show correlation with the concurrently recorded pupil area. The temporal dynamics found confirm two earlier studies of sinigle-unit responses and quantitative nerve stimulation. Both of these indicate that most of the 200-millisecond transport delay resides in the neuromuscular apparatus. Neurons whose activity correlated either with constriction with dilatation phases of Change in the pupil area were observed.
Pupil diameters in the dark, in the light, and after mydriasis with tropicamide+ phenylephrine have been measured in 25 patients before and six months after cataract surgery. The aphakic pupil showed reduced mobility as evidenced by a smaller diameter in the and a larger one in the light. In patients who had intracapsular extraction or extracapsular extraction with intraocular lens implantation the pupils dilated less well than preoperatively. The difference in response to mydriatics is of practical importance in the assessment and treatment of peripheral retinal disorders in aphakic and pseudophakic eyes.
The human eye was studied to investigate its use as a noninvasive marker of circadian phase state. Subjects were measured every 30 min over 24 h to observe bilateral changes in pupil size and palpebral fissure. Twelve males and twelve females (ages 18-29 yr, mean = 21.6 yr) were studied around the clock while they remained within a light-controlled facility (< 100 lux). The acrophases (maximums) for pupil diameters and palpebral fissure distances were estimated using a cosine curve-fitting technique applied to each 24-h data set. Pupil diameter acrophases occurred randomly throughout the day. The data demonstrated a significant circadian rhythm for both resting and maximum palpebral fissure values. However, palpebral fissure acrophases were widely distributed, with the largest portion of the peaks occurring between 10:00 A.M. and 10:00 P.M.. These data did not support the hypotheses that sympathetic innervation to the pineal is paralleled in the eye, and results do not demonstrate any applicability of human eye measurements as circadian markers.
A 52-year-old woman was diagnosed as having Adie's tonic pupil in her right eye. She reported few episodes of blurring of vision in her right eye in the recent few months. On one of the routine follow-up visits, right intraocular pressure (IOP) was 70 mm Hg and on gonioscopy the angle was closed 360 degrees. Medical treatment resulted in IOP reduction and laser iridotomy was then performed. This is, to our knowledge, the first description of intermittent angle-closure glaucoma attacks induced by a tonic pupil. The possibility of angle-closure glaucoma should be considered in patients with a tonic pupil, especially with symptoms of blurred vision or ocular pain.
INTRODUCTION: Ophthalmological manifestations of systemic malignancies can be either direct, metastatic or paraneoplastic. The latter are remote effects of carcinoma, often caused by autoantibodies. Ophthalmological manifestations include cancer-associated retinopathy, melanoma-associated retinopathy, opsoclonus-myoclonus syndrome or motility disorders due to effects on the neurological system. A unilateral tonic pupil is usually a benign finding but has also been described in the context of paraneoplastic syndromes, in some cases associated with anti-Hu antibodies. CASE REPORTS: The authors describe 2 patients with bilateral symptomatic tonic pupils due to a paraneoplastic syndrome. Both patients had been treated for small cell lung cancer and had evidence of anti-Hu antibodies (autoantibodies against nuclei of neural cells) in serum and cerebrospinal fluid. Both had typical pupillary findings and hypersensitivity to diluted pilocarpine. The first patient also had sensory neuronopathy, the second affection of several cranial nerves. DISCUSSION: To the best of our knowledge, to date no case of bilateral tonic pupils has been published due to a paraneoplastic disorder with evidence of autoantibodies. This is surprising, as it is probable that autoantibodies in paraneoplastic disorders affect both ciliary ganglions in a similar way.
The latent period of the pupil light reflex was investigated by means of infrared pupillography in patients suffering from optic neuritis (retrobulbar neuritis, papillitis), papilledema, optic atrophy or anterior ischemic optic neuropathy. The inflammatory diseases of the optic nerve and the optic atrophy cause significant prolongation of the latent period of the pupil light reflex. Conversely, in papilledema no prolonged latent period could be demonstrated. The vascular diseases of the optic nerve affect the pupil latent period also, however, to a lower degree.