The pupillary size and movement are controlled dynamically by the autonomic nervous system; the parasympathetic system constricts the iris, while the sympathetic system dilates the iris. Under normal conditions, these constrictions and dilations occur identically in both eyes. Asymmetry in the pupillomotor neural input or output leads to impaired pupillary movement on one side and an unequal pupil size between both eyes. Anisocoria is one of the most common signs in neuro-ophthalmology, and the neurological disorders that frequently cause anisocoria include serious diseases, such as vascular dissection, fistula, and aneurysm. A careful history and examination can identify and localize pupillary disorders and provide a guide for appropriate evaluations.
Aneurysm ; Anisocoria ; Autonomic Nervous System ; Constriction ; Fistula ; Horner Syndrome ; Iris ; Nervous System Diseases ; Pupil ; Pupil Disorders ; Tonic Pupil

The pupillary size and movement are controlled dynamically by the autonomic nervous system; the parasympathetic system constricts the iris, while the sympathetic system dilates the iris. Under normal conditions, these constrictions and dilations occur identically in both eyes. Asymmetry in the pupillomotor neural input or output leads to impaired pupillary movement on one side and an unequal pupil size between both eyes. Anisocoria is one of the most common signs in neuro-ophthalmology, and the neurological disorders that frequently cause anisocoria include serious diseases, such as vascular dissection, fistula, and aneurysm. A careful history and examination can identify and localize pupillary disorders and provide a guide for appropriate evaluations.
Aneurysm ; Anisocoria ; Autonomic Nervous System ; Constriction ; Fistula ; Horner Syndrome ; Iris ; Nervous System Diseases ; Pupil ; Pupil Disorders ; Tonic Pupil

A Dilated pupil with a loss of reactions to light and accommodation convergence exhibit these defects in varying degree, and occur under a variety of circumstances. These conditions include unilateral dilatation and fixity of the pupil as a result of injury to the eye and as the result of ipsilateral cerebral compression and bilaterally dilated and fixed pupils seen commonly in juvenile paresis and tabo-paresis. There are another unknown circumstances as tonic pupil. The authors presented a case of 22 years old Korean female under the diagnosis of dilated and fixed pupil which possibly originated from syphilis in as much as she was strongly positive reaction in serum S.T.S. and her abnormal pupil was recovered after anti-syphilitic therapy. The authors reviewed the literatures concerning these conditions and discussed about the possibility of early involvement of syphilis in the nervous system and the possible site of lesion which interefere pupillary reflex to light and accommodation-convergence. Finally authors commented the possible site of lesion is efferent pupilloconstrictor fibers which pass through the tentorial gap. In this region para-sympathetic pupilloconstrictor fibers, concentrated over the superior are of the oculomotor nerve, may be compressed upon its superior surface by inflammatory swelling of syphilitic involvement of adjacent structures.
Diagnosis ; Dilatation ; Female ; Humans ; Nervous System ; Neurosyphilis ; Oculomotor Nerve ; Pupil ; Pupil Disorders* ; Reflex, Pupillary ; Syphilis ; Tonic Pupil ; Young Adult

PURPOSE: We report a case of bilateral tonic pupils and decreased corneal sensitivity in a patient with Vogt-Koyanagi-Harada (VKH) disease during pregnancy. CASE SUMMARY: A 33-year-old Korean woman in the sixth month of pregnancy presented with visual impairment in both eyes. Her best corrected visual acuity was 0.2 in the right eye and 0.125 in the left. Slit-lamp examination revealed cells in the anterior chamber and serous retinal detachments in both eyes. The patient was treated with topical corticosteroid in both eyes and posterior subtenon injection of triamcinolone acetonide in the left eye. The serous retinal detachment resolved completely at 2 months in the left eye and at 3 months in the right. As pigmentation of the retina developed, VKH disease was confirmed. The patient complained of photophobia, and both pupils were found to be enlarged to 8 mm without dilation. Light reflex was absent and near reflex was suppressed and slow. After instillation of 0.125% pilocarpine, the pupils were constricted to 3.5 mm and were diagnosed as tonic pupils. Though the patient's corrected visual acuity improved to 0.8 in the right eye and 1.0 in the left at 6 months, her pupils remained unchanged. Corneal sensitivity was decreased. CONCLUSIONS: Tonic pupils may be complicated with VKH disease even during pregnancy. We recommend examinations of the pupils and corneal sensitivity in patients with VKH disease, especially those complaining of photophobia.
Adult ; Anterior Chamber ; Female ; Humans ; Photophobia ; Pigmentation ; Pilocarpine ; Pregnancy ; Pupil ; Reflex ; Retina ; Retinal Detachment ; Tonic Pupil* ; Triamcinolone Acetonide ; Uveomeningoencephalitic Syndrome* ; Vision Disorders ; Visual Acuity

PURPOSE: To report an case regarding phacoemulsification and intraocularlens (IOL) implantation using an iris retractor in a congenital microcoria patient. CASE SUMMARY: A 53-year-old male patient visited the office with a complaint of gradual decrease of visual acuity. The patient's best corrected visual acuity (BCVA) was 0.3, and his refractive index could not be measured, as a very small pupil was observed in both eyes. After applying tropicamide and phenylephrine four times, the refractive index of both eyes remained immeasurable. In addition, on slit-lamp biomicroscopic examination, a nucleosclerotic cataract was observed in both eyes. Any signs of increased intraocular pressure or gonioscopic findings seen in glaucomatous patients was not detected in either eyes. Using an ultrasound biomicroscope and Pentacam, the pupil diameter were 0.31 mm in both eyes, and changed to 0.92 mm in the right eye, and 1.0 mm in the left eye, after applying mydriatics. Phacoemulsification and IOL implantation were performed one month apart from each other, using an iris retractor. On the follow-up examination 2 to 3 months postoperatively, BCVA was 0.7 in the right eye, and 1.0 in the left eye. After the operation, the pupil diameter was not changed before and after mydriasis, and measured 2.53 mm in the right eye, and 2.83 mm in the left eye. CONCLUSIONS: The authors have reported a case regarding visual acuity that improved in a congenital microcoria patient performing a phacoemulsification and IOL implantation operation using an iris retractor.
Cataract ; Eye ; Follow-Up Studies ; Humans ; Intraocular Pressure ; Iris ; Male ; Middle Aged ; Miosis ; Mydriasis ; Mydriatics ; Phacoemulsification ; Phenylephrine ; Pupil ; Pupil Disorders ; Refractometry ; Tropicamide ; Visual Acuity

PURPOSE: To report the clinical features of Adie's tonic pupil. METHODS: The medical records of 22 patients who had been diagnosed with Adie's tonic pupil from February 1998 to February 2009, were retrospectively reviewed. On March 2010, a cross-sectional examination was performed in 16 patients (19 eyes) who underwent a follow-up of more than 1 year. Measurements included pupil size in room light, bright light and in darkness; near point of accommodation; presence of segmental iris palsy; light-near dissociation; denervation supersensitivity; corneal sensitivity; and deep tendon reflex (DTR). RESULTS: Among the patients studied, 16 were women in Adie's tonic pupils. Only 3 of patients had bilateral involvement. The mean age of onset was 38.3 years. The mean size of Adie's tonic pupils was 2.3 mm larger than the fellow eyes. Segmental iris palsy was detected in 93.8% of the patients. Denervation supersensitivity was observed in all patients. Light-near dissociation was present in 88.2% and over 90% of the patients had decreased DTR in the biceps, triceps, knee and ankle jerk. CONCLUSIONS: This cross-sectional study showed Adie's tonic pupil tended to become miotic and recover accommodation power over the years.
Age of Onset ; Animals ; Ankle ; Cross-Sectional Studies ; Denervation ; Dissociative Disorders ; Eye ; Female ; Follow-Up Studies ; Humans ; Iris ; Knee ; Light ; Medical Records ; Paralysis ; Pupil ; Reflex, Stretch ; Retrospective Studies ; Tonic Pupil

In Bach Mai Hospital from May 1998 to June 2002, 23 children aged 10-15 (15 girls and 8 boys) with malformation of brain vessel were diagnosed definitely. Most of under 11-year-old children have swelling vessel, 30.4% of above 11-year-old children have AVM malformation - 52.1%. The main manifestations of brain vessel malformation are hemorrhage of brain lobe 65.2%, subarachroid hemorrhage 39.1%, brain ischemia 30.4%, epilepxy or epileptic conditions 21.7%, head pain of migraine type 17.4%. Unilateral palsy of III nerve is specific sign for diagnosis of swelling of prosterior communicating artery with a rate of 8.7%. Dysphasia is temporary, while the visual dysfunction is more persistent
Child ; Pupil Disorders ; Nervous System Malformations

Rieger's anomaly refers to a dysgenesis that features bilateral hypoplasia of the iris stroma, posterior embryotoxon and the associated angle anomalies, pupillary distortion, polycoria, and a high likelihood of glaucoma. In addition to glaucoma, other defects, usually dental, may be present in Rieger's anomaly. When glaucoma occurs, it usually develops during the first to third decades but infrequently occurs in infancy. Frequently mesodermal dysgenesis accompanies ectopia of the pupil and polycoria. In these anomalies no new synechias are formed such as occur in essential iris atrophy. Cataracts are occasionally part of the picture. The anomaly is extremely variable in its expression with the full-blown disease in one member of a family and only minimun signs in another. The authors experienced a case of Rieger's anomaly which occurred in both eyes of 18 year old male who had above characteristic ocular findings and associated juvenile onset glaucoma.
Adolescent ; Atrophy ; Cataract ; Glaucoma ; Humans ; Iris ; Male ; Mesoderm ; Pupil ; Pupil Disorders

A unilated cataract had been reported to cause a relative afferent pupillary defect (RAPD) in the contralateral eye. After extraction of the cataract, the RAPD disappeared in every case. The ability of cataracts to induce an RAPD in the opposite eye is presumed to increased intraocular scatter of light by the cataract, stimulating more peripheral photoreceptors. This observation has not been reported in Korea. The authors have also observed RAPD in the contralateral eye to the unilateral cataract in six patients, disappearing after cataract surgery. Thus, when an RAPD is seen in an eye with a cataract, a visual pathway defect in that eye should definitely be suspected. In addition, it would be better to hold the brain imaging study when an RAPD is noticed in the contralateral eye to the unilateral cataract and to confirm the normal pupillary reflex in both eyes after the cataract surgery.
Cataract* ; Humans ; Korea ; Neuroimaging ; Pupil Disorders* ; Reflex, Pupillary ; Visual Pathways

PURPOSE: To investigate the incidence, associated factors, and the prognostic significance of relative afferent papillary defect (RAPD) in the eyes with less severe cataract and determine which mechanism of 'scattering' or 'dark adaptation' is more applicable, we evaluated 40 patients with asymmetric cataract (AC). METHODS: Forty patients of AC with the differences of three lines or more of visual acuity by Han's visual acuity chart underwent ophthalmic examinations including the 'swinging flashlight test' and electroretinogram before and after cataract surgery. RESULTS: There were nineteen patients who showed definite RAPD in the eyes with less severe cataract. The differences of log MAR between the two eyes were more than 1.55 or less than 0.73 in 17 patients (89.5%) with RAPD. Degree of posterior subcapsular opacity was marginally associated with RAPD in the eyes with less than 1.06 of log MAR differences. There was no association between the presence of RAPD and postoperative visual acuities. In the eyes with RAPD, b wave amplitudes tended to be smaller in the eyes with more severe cataract than those with less severe cataract before dark adaptation. However, after dark adaptation, b wave amplitudes tended to be larger in eyes with more severe cataract than those in the eyes with less severe cataract, and preoperatively than postoperatively. CONCLUSIONS: The incidence of RAPD of less severe cataract eye was significant (48%) but RAPD was not associated with visual acuity prognosis. The results of electroretinogram more favored 'scattering ' than 'dark adaptation' as the mechanism of RAPD phenomenon.
Cataract* ; Dark Adaptation ; Humans ; Incidence ; Prognosis ; Pupil Disorders* ; Visual Acuity