Impaired pupillary light reflex indices in Orbital Apex Syndrome - A rare case report.
Dynamic pupillometry
Fissure supraorbitaire
Pupillary light reflex
Pupillométrie dynamique
Réflexe lumineux pupillaire
Supraorbital fissure
Journal
Journal francais d'ophtalmologie
ISSN: 1773-0597
Titre abrégé: J Fr Ophtalmol
Pays: France
ID NLM: 7804128
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
28
05
2020
revised:
08
06
2020
accepted:
11
06
2020
pubmed:
9
2
2021
medline:
19
8
2021
entrez:
8
2
2021
Statut:
ppublish
Résumé
The clinical presentation of reduced pupillary responses in orbital apex syndrome is currently not well understood clinically. The pupillary light reflex (PLR) is determined using dynamic pupillometry. A newly diagnosed 35-year-old diabetic female patient had ocular symptoms including orbital pain and ptosis, but no visual loss. Cranial nerve autonomic impairment was identified with dynamic pupillometry and compared with cardiac autonomic activity using heart rate variability (HRV). PLR showed that pupil size and response were severely affected, with a small resting pupil size, and minimal response to a bright white light flash was seen, due to decreased sympathetic activity. However, HRV showed normal cardiac sympathetic activity. These findings suggest that orbital apex syndrome may lead to changes in pupil size and response due to compression of sympathetic fibers at the apex of the orbit. Quantitative PLR measurements help to reveal relevant information on anatomical reflex pathways.
Sections du résumé
BACKGROUND
BACKGROUND
The clinical presentation of reduced pupillary responses in orbital apex syndrome is currently not well understood clinically. The pupillary light reflex (PLR) is determined using dynamic pupillometry.
CASE DETAILS
METHODS
A newly diagnosed 35-year-old diabetic female patient had ocular symptoms including orbital pain and ptosis, but no visual loss. Cranial nerve autonomic impairment was identified with dynamic pupillometry and compared with cardiac autonomic activity using heart rate variability (HRV).
RESULTS
RESULTS
PLR showed that pupil size and response were severely affected, with a small resting pupil size, and minimal response to a bright white light flash was seen, due to decreased sympathetic activity. However, HRV showed normal cardiac sympathetic activity.
CONCLUSION
CONCLUSIONS
These findings suggest that orbital apex syndrome may lead to changes in pupil size and response due to compression of sympathetic fibers at the apex of the orbit. Quantitative PLR measurements help to reveal relevant information on anatomical reflex pathways.
Identifiants
pubmed: 33551108
pii: S0181-5512(21)00039-5
doi: 10.1016/j.jfo.2020.06.046
pii:
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
718-722Informations de copyright
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