Abstract
Due to in-depth neuroanatomical and functional knowledge, the clinical examination of the pupils is considered an indicator of optic nerve conduction, brainstem integrity, vigilance, and coma. The autonomic nervous system regulates pupil size in response to various stimuli. The parasympathetic nervous system causes miosis in response to light and near visual stimuli. The sympathetic nervous system causes mydriasis in the dark and in response to a variety of arousal factors, both physiological such as wakefulness and pathological such as pain. The clinical approach to pupillary abnormalities must focus on the clinical and pharmacological assessment of the pupil’s response to light and near stimuli. Observation and quantification of responses to physiological tests can be supplemented with specific pharmacological tests to detect damage to sympathetic or parasympathetic innervation. Local or generalized disorders of the autonomic nervous system, also affect neural control of lacrimation. Abnormal lacrimation can be divided into hypo lacrimation, excessive lacrimation or epiphora, and inappropriate lacrimation. Generalized disorders, including Riley Day syndrome or familial dysautonomia and multisystem atrophy or PAF, will be discussed in the chapter.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
McDougal DH, Gamlin PD. Autonomic control of the eye. Eye Compr Physiol. 2015;5(1):439–73.
May P, Sun W, Wright NF, Erichsen JT. Pupillary light reflex circuits in the macaque monkey: the preganglionic Edinger-Westphal nucleus. Brain Struct Funct. 2020;225:403–25.
Gamlin Paul DR. Subcortical neural circuits for ocular accommodation and vergence in primates. Ophthal Physiol Opt. 1999;19(2):81–9.
Kelbsch C, Strasser T, Chen Y, et al. Standards in pupillography. Front Neurol. 2019;10:129.
Khan Z, Bollu PC. Horner syndrome. In: StatPearls. StatPearls Publishing; 2018.
Morales J, Brown SM, Abdul-Rahim AS, Crosson CE. Ocular. J Neuroophthalmol. 2010;30(1):7–11.
Almog Y, Gepstein R, Kesler A. Diagnostic value of imaging in Horner syndrome in adults. J Neuroophthalmol. 2010;30(1):7–11.
Biousse V, Touboul PJ, D’Anglejan-Chatillon J, Lévy C, Schaison M, Bousser MG. Ophthalmologic manifestations of internal carotid artery dissection. Am J Ophthalmol. 1998;126(4):565–77.
Ludwig PE, Jessu R, Czyz CN. Physiology, eye. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2022.
Miller N, Kanagalingam S. Horner syndrome: clinical perspectives. Eye Brain. 2015;7:35–46.
Smit DP. Pharmacological testing in Horner’s syndrome—a new paradigm. S Afr Med J. 2010;100(11):738–40.
Bremner F. Apraclonidine is better than cocaine for detection of Horner syndrome. Front Neurol. 2019;10:55.
Koc F. The sensitivity and specificity of 0.5% apraclonidine in the diagnosis of oculosympathetic paresis. Br J Ophthalmol. 2005;89(11):1442–4.
Nguyen MTB, Farahvash A, Zhang A, Micieli JA. Apraclonidine for the pharmacologic confirmation of acute Horner syndrome. J Neurol Sci. 2020;419:117190.
Martin GC, Aymard P-A, Denier C, et al. Usefulness of cocaine drops in investigating infant anisocoria. Eur J Paediatr Neurol. 2017;21(6):852–7.
Danesh-Meyer HV. The correlation of phenylephrine 1% with hydroxyamphetamine 1% in Horner’s syndrome. Br J Ophthalmol. 2004;88(4):592–3.
Pronin AN, Wang Q, Slepak VZ. Teaching an old drug new tricks: agonism, antagonism, and biased signaling of pilocarpine through M3 muscarinic acetylcholine receptor. Mol Pharmacol. 2017;92(5):601–12.
Yoo Y-J, Hwang J-M, Yang HK. Dilute pilocarpine test for diagnosis of Adie’s tonic pupil. Sci Rep. 2021;11:10089.
Rivero RodrÃguez D, Scherle Matamoros C, Pernas SY. Adie pupil. Pilocarpine test. Med ClÃn (Engl Ed). 2018;151(4):170.
Cho P, Yap M. Schirmer test. I. A review. Optom Vis Sci. 1993;70(2):152–6.
Sweeney DF, Millar TJ, Raju SR. Tear film stability: a review. Exp Eye Res. 2013;117:28–38.
Bouffard MA. The pupil. Continuum (Minneap Minn). 2019;25:1194–214.
Brazis PW, Lee AG. In: Low A, Benarroch EE, editors. Clinical autonomic disorders. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 588–606.
Bremner FD, Smith SE. Pupil abnormalities in selected autonomic neuropathies. J Neuroophthalmol. 2006;26(3):209–19.
Lamotte G, Sandroni P, Cutsforth-Gregory JK, et al. Clinical presentation and autonomic profile in Ross syndrome. J Neurol. 2021;268(10):3852–60.
Brazis PW, Lee AG. In: Low A, Benarroch EE, editors. Clinical autonomic disorders. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 606–9.
Benarroch EE. The central autonomic network: functional organization, dysfunction, and perspective. Mayo Clin Proc. 1993;68(10):988–1001.
Leone M, Bussone G. Pathophysiology of trigeminal autonomic cephalalgias. Lancet Neurol. 2009;8(8):755–64.
Cortelli P, Pierangeli G. Chronic pain-autonomic interactions. Neurol Sci. 2003;24(S2):s68–70.
Guo S, Petersen AS, Schytz HW, et al. Cranial parasympathetic activation induces autonomic symptoms but no cluster headache attacks. Cephalalgia. 2018;38(8):1418–28.
Drummond PD. Autonomic disturbances in cluster headache. Brain. 1988;111(5):1199–209.
May A, Burstein R. Hypothalamic regulation of headache and migraine. Cephalalgia. 2019;39(13):1710–9.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211.
Cortelli P, Pierangeli G. Hypothalamus and headaches. Neurol Sci. 2007;28(S2):S198–202.
Danno D, Wolf J, Ishizaki K, Kikui S, Yoshikawa H, Takeshima T. Cranial autonomic symptoms of migraine in Japan: prospective study of 373 migraine patients at a Tertiary Headache Center. Headache. 2020;60(8):1592–600.
Sharav Y, Katsarava Z, Charles A. Facial presentations of primary headache disorders. Cephalalgia. 2017;37(7):714–9.
de Coo IF, Wilbrink LA, Haan J. Symptomatic trigeminal autonomic cephalalgias. Curr Pain Headache Rep. 2015;19(8):39.
Burish MJ, Rozen TD. Trigeminal autonomic cephalalgias. Neurol Clin. 2019;37(4):847–69.
Giffin NJ, Lipton RB, Silberstein SD, Olesen J, Goadsby PJ. The migraine postdrome: an electronic diary study. Neurology. 2016;87(3):309–13. https://doi.org/10.1212/WNL.0000000000002789. Epub 2016 Jun 22.
Goadsby PJ, Lambert GA, Lance JW. The mechanism of cerebrovascular vasoconstriction in response to locus coeruleus stimulation. Brain Res. 1985;326(2):213–7. https://doi.org/10.1016/0006-8993(85)90030-7.
Bose P, Karsan N, Goadsby PJ. The migraine postdrome. Continuum (Minneap Minn). 2018;24(4, Headache):1023–31. https://doi.org/10.1212/CON.0000000000000626.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Romano, M., Di Leo, R., Mascarella, D., Pierangeli, G., Rufa, A. (2023). Pupillary and Lacrimation Alterations. In: Micieli, G., Hilz, M., Cortelli, P. (eds) Autonomic Disorders in Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-031-43036-7_17
Download citation
DOI: https://doi.org/10.1007/978-3-031-43036-7_17
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-43035-0
Online ISBN: 978-3-031-43036-7
eBook Packages: MedicineMedicine (R0)