Pupillary Disorders Research Articles

The Pupil and Its Disorders

Pertinent information concerning the pupil is provided for the practicing and aspiring neurologist, including anatomy and physiology of the normal pupil, a discussion of pupillary disorders, and unusual pupillary abnormalities.

The tonic pupul; familial incidence, recognition, and progression.

Both parents and three of their seven offspring affected with the tonic pupil illustrate either a dominant type of inheritance or a double recessive with imperfect penetrance in this pupillary disorder. There was an acute onset with loss of accomodation, an initial lack of hypersensitivity to methacholine chloride and a period of postganglionic regeneration during which the pupil became smaller, accommodation returned, and the methacholine chloride test became positive in two of the three affected children. These characteristics are not part of the usual picture of the tonic pupil of inconspicuous onset, which reacts positively to 2.5% methacholine chloride.

Miosis in Argyll Robertson syndrome and related pupillary disorders.

According to the classical description,* the Argyll Robertson syndrome is characterized by the following essential features: (1) the absence or diminution of the pupillary reflex to light; (2) an active or hyperactive pupillary contraction to near vision, and (3) the presence of miosis. The cause of the miosis in the Argyll Robertson syndrome and in related pupillary disturbances has never been satisfactorily explained. In the abundant literature, extending over almost a century, two main theories have evolved: The miosis is due to an interruption of the sympathetic dilator fibers. The miosis is due to irritation within the parasympathetic reflex arc. It is the purpose of this paper to discuss, on the basis of pupillographic and pharmacodynamic tests, the mechanism by which miosis is produced in the Argyll Robertson and related pupillary syndromes. An attempt will be made to clarify some of the basic problems which have perpetuated the controversies involved.

SITE OF DISTURBANCE IN ADIE'S SYNDROME

Adie's syndrome has frequently been reported from Germany and England but rarely from this country. The entity consists essentially of tonic pupillary reactions with or without absence of tendon reflexes. As will be seen later, it manifests itself in several forms. The so-called myotonic pupil was first described almost simultaneously in 1902 by Strasburger 1 and Saenger, 2 though their observations were made independently. This type of pupillary reaction, as described by these authors, consisted of very slow contraction to light and in convergence and accommodation, followed by an even slower dilation on removing the stimuli. The amplitude of the convergence reaction was normal or even excessive. The light reaction was the most sluggish, and in one of Strasburger's original cases it was absent entirely. From that time until the present, numerous articles on this pupillary disorder have appeared in the medical literature. Various names have been proposed for the