New aspects of retinal and cortical input to the pupil light reflex and clinical implications

摘要

Objective :To introduce the major questions surrounding the use of the pupil light reflex used to quantify and localizediseases in the visual pathways from retina to brain. Background New information has emerged in recent years, which helps to elucidate the input and organization of neuronsmediating the pupil light reflex and their projections to the brain. Knowledge of the response properties of these neuronsmay provide a basis for localizing the site of damage and how to best select characteristics of light stimuli which providethe most information about the pupil light reflex and visual input. Method Examples of different types and sites of pathology of the visual pathway were studied by pupillography to understand how new information about the pupil light reflex might explain previously misunderstood results of pupil testing. Properties of light stimuli such as intensity, size, perimetric location, duration, and color were studied. Results Pupil light reflex shape, duration, size, and correlation to visual field location and retinal nerve fiber layer thickness were useful in localizing the etiology and site of damage. Conclusion Knowledge of response properties and projections of neurons mediating the pupil light reflex and their relation to diseases of the visual pathways should facilitate its use in the detection, cause, and localization of damage.