Atypical sensory responsivity is widely reported in autistic individuals and is related to elevated functional difficulties. Dynamically, altered initial responses and/or habituation rates could underlie their atypical averaged responses to repeated sensory stimuli. In this study we aimed to measure the arousal level in response to different types of auditory stimuli and the dynamic change of atypical arousal level using pupillometry in autistic children. In Experiment 1, 43 autistic children and 49 neurotypical (NT) children were asked to passively listen to a mild sound and an aversive sound repeatedly. In Experiment 2, 39 autistic children and 44 NT children who went through Experiment 1 listened to a gradually emerging non-startling sound and a suddenly emerging startling sound in a random order. We found that the autistic group showed hyper-arousal in response to the aversive sound and the startling sound as reflected by their larger change in pupil area. In comparison, these autistic children demonstrated normal arousal in response to the mild sound and the non-startling sound. Dynamically, the autistic group had a larger peak pupil area change than the NT group in the first trial and a normal habituation rate to the aversive sound. In summary, our results suggest hyper-arousal to aversive and startling stimuli and the role of larger initial responses in hyper-arousal in autism. Minimizing aversive and startling sensory stimuli or gradually increasing the volume of aversive auditory stimuli to allow autistic children to adapt using the principle of habituation is recommended to reduce the arousal level and problematic behaviors of autistic children.
Humans ; Male ; Child ; Female ; Acoustic Stimulation ; Autistic Disorder/physiopathology* ; Arousal/physiology* ; Pupil/physiology* ; Habituation, Psychophysiologic/physiology* ; Auditory Perception ; Child, Preschool

Perception ; Pupil ; Social Interaction

PURPOSE: We report a case of Urrets-Zavalia syndrome with a fixed dilated pupil after an uneventful trabeculectomy.CASE SUMMARY: Trabeculectomy was performed on a 51-year-old male who had a history of recurrent uveitis in the left eye, with uncontrolled intraocular pressure despite maximally-tolerated medial therapy. There was no unexpected event during surgery. Topical 1% atropine was used for only 2 days after surgery. In the early postoperative period, 1% prednisolone and 0.3% ofloxacin were given four times a day, then gradually reduced. One month later, only 1% prednisolone was given once a day. Intraocular pressure in his left eye was well controlled from 8–14 mmHg after surgery. One month after surgery, the pupils remained dilated. There was no reaction to topical 2% pilocarpine and no relative afferent pupillary defect or posterior synechia.CONCLUSIONS: Our case, although rare, suggests that Urrets-Zavalia syndrome should be considered in patients with well-controlled intraocular pressure after uneventful trabeculectomy.
Atropine ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Ofloxacin ; Pilocarpine ; Postoperative Period ; Prednisolone ; Pupil ; Pupil Disorders ; Trabeculectomy ; Uveitis

Objective To investigate the application value of eye tracking in lie detection. Methods The 40 subjects were randomly divided into two groups. The pupil diameter, fixation duration, points of fixation and blink frequency of the subjects in the experimental group in observing target stimulation and non-target stimulation were recorded with eye tracker after they accomplished the mock crime. The eye movement parameters of subjects in the control group were directly collected. The differences in eye movement parameters of the experimental group and the control group in observing target stimulation and non-target stimulation were analyzed by t-test. Pearson coefficient analysis of correlation between eye movement parameters that had differences was conducted. The effectiveness of eye movement parameters to distinguish between the experimental group and the control group was calculated by the receiver operator characteristic （ROC） curve. Results Participants from the experimental group had shorter average pupil diameter, longer average fixation duration and fewer fixation points （P<0.05）, but the differences in blink frequency had no statistical significance. The differences in the above indicators of the control group in observing target stimulation and non-target stimulation had no statistical significance. The average fixation duration showed a negative correlation with fixation points （r=-0.255, P<0.05）; the average fixation duration showed a negative correlation with average pupil diameter （r=-0.218, P<0.05）; the fixation points showed a positive correlation with average pupil diameter （r=0.09, P<0.05）. The area under the curve of average pupil diameter, average fixation duration and fixation points was 0.603, 0.621 and 0.580, respectively. Conclusion The average pupil diameter, average fixation duration and fixation points obtained by the eye tracker under laboratory conditions can be used to detect lies.
Algorithms ; Eye Movements ; Humans ; Lie Detection ; Pupil ; Time Factors

BACKGROUND: To objectively investigate accommodative response to various refractive stimuli in subjects with normal accommodation. METHODS: This prospective, non-randomized clinical trial included 64 eyes of 32 subjects with a mean spherical equivalent −1.4 diopters (D). We evaluated changes in accommodative power, pupil diameter, astigmatic value, and axis when visual stimuli were applied to binocular, monocular (dominant eye, non-dominant eye, ipsilateral, and contralateral), and pinhole conditions. Visual stimuli were given at 0.25 D (4 m), 2 D (50 cm), 3 D (33 cm), and 4 D (25 cm) and accommodative response was evaluated using open view binocular autorefractor/keratometer. RESULTS: The accommodative response to binocular stimulus was 90.9% of the actual refractive stimulus, while that of the monocular stimulus was 84.6%. The binocular stimulus induced a smaller pupil diameter than did the monocular stimulus. There was no difference in accommodative response between the dominant eye and non-dominant eye or between ipsilateral and contralateral stimuli. As the refractive stimuli became stronger, the absolute astigmatic value increased and the direction of the astigmatism axis became more horizontal. Pinhole glasses required 10%–15% less accommodative power compared with the monocular condition. CONCLUSION: Binocular stimuli enable more precise and effective accommodation than do monocular stimuli. Accommodative response is composed of 90% true accommodation and 10% pseudo-accommodation, and the refractive stimulus in one eye affects the contralateral eye to the same extent. This should be taken into account when developing guidelines for wearing smart glasses while driving, as visual stimulation is applied to only one eye, but far distance attention is constantly needed. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03557346
Astigmatism ; Eyeglasses ; Glass ; Non-Randomized Controlled Trials as Topic ; Photic Stimulation ; Prospective Studies ; Pupil ; Telescopes*

In brain death state, bilateral pupil light reflexes are disappeared, and pupils are fixed with dilated. However, spontaneous movements such as ocular microtremor or bilateral cyclical constriction-dilatation of pupils have been rarely reported in brain death patients. We present a brain death patient whose right pupil displayed spontaneously repetitive constriction and dilatation regardless of external stimuli such as light and pain. Early recognition of this phenomenon may prohibit the delay in the diagnosis of brain death and organ transplantation.
Brain Death ; Brain ; Coma ; Constriction ; Diagnosis ; Dilatation ; Humans ; Organ Transplantation ; Pupil ; Reflex ; Transplants

PURPOSE: To report a case of pituitary apoplexy presenting as isolated bilateral oculomotor nerve palsy. CASE SUMMARY: A 46-year-old male presented with bilateral ptosis and acute severe headaches for 6 days. He underwent head surgery and bilateral vitrectomy 12 years prior to his visit because of ocular and head trauma. He mentioned that previous visual acuities in both eyes were not good. The initial corrected visual acuity was finger counting in the right eye and 20/500 in the left eye. Ocular motility testing revealed the limitation of adduction, supraduction, and infraduction with complete bilateral ptosis in both eyes, and his left pupil was dilated. He was diagnosed with an isolated bilateral oculomotor nerve palsy. Magnetic resonance imaging indicated pituitary gland hemorrhage with a tumor, which was suspicious of pituitary apoplexy. The patient was treated intravenous with 1.0 g methylprednisolone to prevent the corticotropic deficiency. In addition, he underwent surgical decompression using a navigation-guided transsphenoidal approach and aspiration biopsy. He was confirmed with pituitary adenoma using a pathological examination. The patient's ocular movements began to dramatically improve by the third day postoperatively. At 4 months postoperative follow-up, his ocular movement and double vision were completely recovered. CONCLUSIONS: This was a rare case of pituitary apoplexy with bilateral isolated oculomotor nerve palsy, which was the first report in the Republic of Korea. A full recovery was achieved after early surgical treatment.
Biopsy, Needle ; Cranial Nerve Diseases ; Craniocerebral Trauma ; Decompression, Surgical ; Diplopia ; Fingers ; Follow-Up Studies ; Head ; Headache ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Male ; Methylprednisolone ; Middle Aged ; Oculomotor Nerve Diseases ; Oculomotor Nerve ; Pituitary Apoplexy ; Pituitary Gland ; Pituitary Neoplasms ; Pupil ; Republic of Korea ; Visual Acuity ; Vitrectomy

PURPOSE: To report a case of optic neuritis accompanied by optic perineuritis after retinalamin peribulbar injection. CASE SUMMARY: A 46-year-old Kazakhstan woman presented with sudden vision loss, headache, and pain in both eyes which began 2 hours after the peribulbar injection of retinalamin approximately 10 days prior to her initial visit. At the initial visit, the best-corrected visual acuity was light perception in both eyes. A fundus examination showed bilateral optic disc swelling and fluorescein angiography showed late-phase leakage around the optic nerve and optic nerve sheath enhancement. On brain magnetic resonance imaging, the tram track sign and donut sign were seen in both eyes. Steroid pulse therapy was started after the diagnosis of optic neuritis accompanied by optic perineuritis. After 6 months, the patient's visual acuity improved up to 0.8 in the right eye and 1.0 in the left eye. The light reflex was recovered, the relative afferent pupillary defect decreased, and there was no evidence of optic disc swelling. CONCLUSIONS: When an unverified drug injection is performed (e.g., retinalamin), it could result in complications such as optic neuritis and optic perineuritis from an allergic reaction or peribulbar injection trauma. In such cases, high-dose steroid pulse therapy may be considered.
Brain ; Diagnosis ; Female ; Fluorescein Angiography ; Headache ; Humans ; Hypersensitivity ; Kazakhstan ; Magnetic Resonance Imaging ; Middle Aged ; Optic Nerve ; Optic Neuritis ; Pupil Disorders ; Reflex ; Visual Acuity

PURPOSE: We report a case of acute visual loss with ophthalmoplegia after prone position spinal surgery who had blood supply dependence on collateral circulation due to occlusion of the Internal carotid artery. CASE SUMMARY: A 74-year-old man was referred to the department of ophthalmology for acute visual loss and ophthalmoplegia after lumbar spine surgery performed in prone position. On the initial visit, his right visual acuity was 0.8 and the left visual acuity was negative light perception. Intraocular pressure was normal. There was a relative afferent pupillary defect and ophthalmoplegia of all directions in the left eye. Because of the ptosis of the upper eyelid in the left eye, it was impossible to tune the eye voluntarily. The cherry red spot and pale retina were observed on the fundus examination. On brain magnetic resonance imaging angiography, we found complete obstruction of the left internal carotid artery. He had intravenous injection of 1 g methylprednisolone for 3 days, and discharged with per oral medicine. After 1 month of treatment, the ophthalmoplegia was slightly improved, but visual acuity was not recovered. CONCLUSIONS: In this case, unlike previous reports, acute visual loss and ophthalmoplegia occurred after spinal surgery the patient who had collateral circulation for ocular blood supply because of complete obstruction of the left internal carotid artery. This report highlights the importance of being aware of the anatomical variant in possible complications of external ocular compression after non-ocular surgery.
Aged ; Angiography ; Brain ; Carotid Artery, Internal ; Collateral Circulation ; Eyelids ; Humans ; Injections, Intravenous ; Intraocular Pressure ; Magnetic Resonance Imaging ; Methylprednisolone ; Ophthalmology ; Ophthalmoplegia ; Oral Medicine ; Prone Position ; Pupil Disorders ; Retina ; Retinal Artery Occlusion ; Spine ; Visual Acuity

PURPOSE: To report a case of frosted branch angiitis (FBA) associated with Epstein-Barr virus (EBV) infection in a child. CASE SUMMARY: A 7-year-old boy presented with bilateral blurred vision. On ophthalmic examination, his best-corrected visual acuity was 20/25 in the right eye and 20/32 in the left eye. The pupils were equal, round, and reactive to light without a relative afferent pupillary defect. He had normal color vision in both eyes. Slit-lamp examination revealed no abnormalities in the anterior parts of the eyes. Fundoscopic examination revealed prominent white sheathing retinal vasculitis predominantly on the veins in all quadrants, as well as macular edema and irregular foveal reflex in both eyes. Fluorescein angiography showed normal blood flow, but late diffuse staining and leakage of the affected vessels. Spectral domain optical coherence tomography (SD-OCT) showed thickening of the vessel walls, swelling due to hyperreflective material, and hyperreflective retinal depositions. Serological tests and the serum polymerase chain reaction for EBV were positive. A diagnosis of FBA associated with EBV was made. He was treated with systemic acyclovir and steroids. The response was rapid, with improvement in visual acuity to 20/20 in both eyes by day 3. After 7 weeks, all clinical signs resolved and SD-OCT examination showed normal vessel wall thickness and the absence of hyperreflective depositions. CONCLUSIONS: EBV may present with FBA even in the absence of a systemic sign of primary EBV infection. Thus, EBV should be considered as the etiology of FBA.
Acyclovir ; Child ; Color Vision ; Diagnosis ; Epstein-Barr Virus Infections ; Fluorescein Angiography ; Herpesvirus 4, Human ; Humans ; Macular Edema ; Male ; Polymerase Chain Reaction ; Pupil ; Pupil Disorders ; Reflex ; Retinal Vasculitis ; Retinaldehyde ; Serologic Tests ; Steroids ; Tomography, Optical Coherence ; Vasculitis ; Veins ; Visual Acuity