Pupillometry: Psychology, Physiology, and Function
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AD Singh1, PA Rundle1, a Berry-Brincat1, MA Parsons2 and and Accommodation Were Considered Normal
Tadpole pupil KL Koay et al 93 5 Currie ZI, Rennie IG, Talbot JF. Retinal vascular changes associated with transpupillary thermotherapy for choroidal melanomas. Retina 2000; 20: 620–626. 6 Shields CL, Cater J, Shields JA, Singh AD, Santos MCM, Carvalho C. Combination of clinical factors predictive of growth of small choroidal melanocytic tumors. Arch Ophthalmol 2000; 118: 360–364. 7 Journee-de Korver JG, Oosterhuis JA, de Wolff-Rouendaal D, Kemme H. Histopathological findings in human choroidal melanomas after transpupillary thermotherapy. Br J Ophthalmol 1997; 81: 234–239. 8 Anonymous. Histopathologic characteristics of uveal melanomas in eyes enucleated from the Collaborative Ocular Melanoma Study. COMS report no. 6. Am J Figure 1 Ophthalmol 1998; 125: 745–766. Tadpole-shaped pupil. 9 Diaz CE, Capone Jr A, Grossniklaus HE. Clinicopathologic findings in recurrent choroidal melanoma after transpupillary thermotherapy. Ophthalmology 1998; 105: 1419–1424. periocular sensation. The symptom occurred 10 Singh AD, Eagle Jr RC, Shields CL, Shields JA. Enucleation sporadically, sometimes with several weeks in between following transpupillary thermotherapy of choroidal episodes, but occasionally happening several times on melanoma :clinicopathologic correlations. Arch Ophthalmol the same day. There were no other visual symptoms and (in press). 11 Seregard S, Landau I. Transpupillary thermotherapy as an no significant past ocular history. General health was adjunct to ruthenium plaque radiotherapy for choroidal good and no regular medications were taken. melanoma. Acta Ophthalmologica Scand 2001; 79: 19–22. On examination, visual acuity was normal bilaterally. 12 Keunen JE, Journee-de Korver JG, Oosterhuis JA. There was a 1 mm right ptosis with mild anisocoria, the Transpupillary thermotherapy of choroidal melanoma with right pupil being 1 mm smaller in normal room or without brachytherapy: a dilemma. -
Permeability of the Retina and RPE-Choroid-Sclera to Three Ophthalmic Drugs and the Associated Factors
pharmaceutics Article Permeability of the Retina and RPE-Choroid-Sclera to Three Ophthalmic Drugs and the Associated Factors Hyeong Min Kim 1,†, Hyounkoo Han 2,†, Hye Kyoung Hong 1, Ji Hyun Park 1, Kyu Hyung Park 1, Hyuncheol Kim 2,* and Se Joon Woo 1,* 1 Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; [email protected] (H.M.K.); [email protected] (H.K.H.); [email protected] (J.H.P.); [email protected] (K.H.P.) 2 Department of Chemical and Biomolecular Engineering, Sogang University, Seoul 04107, Korea; [email protected] * Correspondence: [email protected] (H.K.); [email protected] (S.J.W.); Tel.: +82-2-705-8922 (H.K.); +82-31-787-7377 (S.J.W.); Fax: +82-2-3273-0331 (H.K.); +82-31-787-4057 (S.J.W.) † These authors contributed equally to this work. Abstract: In this study, Retina-RPE-Choroid-Sclera (RCS) and RPE-Choroid-Sclera (CS) were prepared by scraping them off neural retina, and using the Ussing chamber we measured the average time– concentration values in the acceptor chamber across five isolated rabbit tissues for each drug molecule. We determined the outward direction permeability of the RCS and CS and calculated the neural retina permeability. The permeability coefficients of RCS and CS were as follows: ganciclovir, 13.78 ± 5.82 and 23.22 ± 9.74; brimonidine, 15.34 ± 7.64 and 31.56 ± 12.46; bevacizumab, 0.0136 ± 0.0059 and 0.0612 ± 0.0264 (×10−6 cm/s). -
Pupillary Disorders LAURA J
13 Pupillary Disorders LAURA J. BALCER Pupillary disorders usually fall into one of three major cat- cortex generally do not affect pupillary size or reactivity. egories: (1) abnormally shaped pupils, (2) abnormal pupillary Efferent parasympathetic fibers, arising from the Edinger– reaction to light, or (3) unequally sized pupils (anisocoria). Westphal nucleus, exit the midbrain within the third nerve Occasionally pupillary abnormalities are isolated findings, (efferent arc). Within the subarachnoid portion of the third but in many cases they are manifestations of more serious nerve, pupillary fibers tend to run on the external surface, intracranial pathology. making them more vulnerable to compression or infiltration The pupillary examination is discussed in detail in and less susceptible to vascular insult. Within the anterior Chapter 2. Pupillary neuroanatomy and physiology are cavernous sinus, the third nerve divides into two portions. reviewed here, and then the various pupillary disorders, The pupillary fibers follow the inferior division into the orbit, grouped roughly into one of the three listed categories, are where they then synapse at the ciliary ganglion, which lies discussed. in the posterior part of the orbit between the optic nerve and lateral rectus muscle (Fig. 13.3). The ciliary ganglion issues postganglionic cholinergic short ciliary nerves, which Neuroanatomy and Physiology initially travel to the globe with the nerve to the inferior oblique muscle, then between the sclera and choroid, to The major functions of the pupil are to vary the quantity of innervate the ciliary body and iris sphincter muscle. Fibers light reaching the retina, to minimize the spherical aberra- to the ciliary body outnumber those to the iris sphincter tions of the peripheral cornea and lens, and to increase the muscle by 30 : 1. -
Sclera and Retina Suturing Techniques 9 Kirk H
Chapter 9 Sclera and Retina Suturing Techniques 9 Kirk H. Packo and Sohail J. Hasan Key Points 9. 1 Introduction Surgical Indications • Vitrectomy Discussion of ophthalmic microsurgical suturing tech- – Infusion line niques as they apply to retinal surgery warrants atten- – Sclerotomies tion to two main categories of operations: vitrectomy – Conjunctival closure and scleral buckling. Th is chapter reviews the surgical – Ancillary techniques indications, basic instrumentation, surgical tech- • Scleral buckles niques, and complications associated with suturing – Encircling bands techniques in vitrectomy and scleral buckle surgery. A – Meridional elements brief discussion of future advances in retinal surgery Instrumentation appears at the end of this chapter. • Vitrectomy – Instruments – Sutures 9.2 • Scleral buckles Surgical Indications – Instruments – Sutures Surgical Technique 9.2.1 • Vitrectomy Vitrectomy – Suturing the infusion line in place – Closing sclerotomies Typically, there are three indications for suturing dur- • Scleral buckles ing vitrectomy surgery: placement of the infusion can- – Rectus muscle fi xation sutures nula, closure of sclerotomy, and the conjunctival clo- – Suturing encircling elements to the sclera sure. A variety of ancillary suturing techniques may be – Suturing meridional elements to the sclera employed during vitrectomy, including the external – Closing sclerotomy drainage sites securing of a lens ring for contact lens visualization, • Closure of the conjunctiva placement of transconjunctival or scleral fi xation su- Complications tures to manipulate the eye, and transscleral suturing • General complications of dislocated intraocular lenses. Some suturing tech- – Break in sterile technique with suture nee- niques such as iris dilation sutures and transretinal su- dles tures in giant tear repairs have now been replaced with – Breaking sutures other non–suturing techniques, such as the use of per- – Inappropriate knot creation fl uorocarbon liquids. -
Affections of Uvea Affections of Uvea
AFFECTIONS OF UVEA AFFECTIONS OF UVEA Anatomy and physiology: • Uvea is the vascular coat of the eye lying beneath the sclera. • It consists of the uvea and uveal tract. • It consists of 3 parts: Iris, the anterior portion; Ciliary body, the middle part; Choroid, the third and the posterior most part. • All the parts of uvea are intimately associated. Iris • It is spongy having the connective tissue stroma, muscular fibers and abundance of vessels and nerves. • It is lined anteriorly by endothelium and posteriorly by a pigmented epithelium. • Its color is because of amount of melanin pigment. Mostly it is brown or golden yellow. • Iris has two muscles; the sphincter which encircles the pupil and has parasympathetic innervation; the dilator which extends from near the sphincter and has sympathetic innervation. • Iris regulates the amount of light admitted to the interior through pupil. • The iris separates the anterior chamber from the posterior chamber of the eye. Ciliary Body: • It extends backward from the base of the iris to the anterior part of the choroid. • It has ciliary muscle and the ciliary processes (70 to 80 in number) which are covered by ciliary epithelium. Choroid: • It is located between the sclera and the retina. • It extends from the ciliaris retinae to the opening of the optic nerve. • It is composed mainly of blood vessels and the pigmented tissue., The pupil • It is circular and regular opening formed by the iris and is larger in dogs in comparison to man. • It contracts or dilates depending upon the light source, due the sphincter and dilator muscles of the iris, respectively. -
Towards a Chromatic Pupillometry Protocol for Assessing Melanopsin-Driven Post-Illumination Pupil Response in Basic Science and Clinical Investigations
TOWARDS A CHROMATIC PUPILLOMETRY PROTOCOL FOR ASSESSING MELANOPSIN-DRIVEN POST-ILLUMINATION PUPIL RESPONSE IN BASIC SCIENCE AND CLINICAL INVESTIGATIONS by Shaobo Lei A thesis submitted in conformity with the requirements for the degree of Master of Science Institute of Medical Science University of Toronto © Copyright by Shaobo Lei 2016 Towards a Chromatic Pupillometry Protocol for Assessing Melanopsin-Driven Post-Illumination Pupil Response in Basic Science and Clinical Investigations Shaobo Lei Master of Science Institute of Medical Science University of Toronto 2016 Abstract The pupillary light reflex (PLR) is mediated by intrinsically photosensitive retinal ganglions cells (ipRGCs), a sub-group of retinal ganglion cells that contain photopigment melanopsin. Melanopsin activation drives a sustained pupil constriction after the offset of light stimulus, this so-called post-illumination pupil response (PIPR) is an in vivo index of melanopsin-driven ipRGC photoactivity. PIPR can be assessed by chromatic pupillometry, but consensus on a standardized PIPR testing protocol has not been reached yet. The purpose of this thesis is to develop an optimized PIPR testing methodology, and to use it to investigate clinical and basic science questions related to melanopsin and ipRGCs. Based on previous pilot work on full-field chromatic pupillometry, a new and repeatable method was developed to measure PIPR induced by hemifield, central-field and full-field light stimulation. This chromatic pupillometry system was then used to investigate a series of basic science and clinical questions related to melanopsin and ipRGCs. ii Acknowledgments I would like to take this opportunity to express my gratitude to a number of people who have helped me to see through this thesis project. -
How the Eye Works
HOW THE EYE WORKS The Eyes & Vision Our ability to "see" starts when light reflects off an object and enters the eye. As it enters the eye, the light is unfocused. The first step in seeing is to focus the light rays onto the retina, which is the light sensitive layer found inside the eye. Once the light is focused, it stimulates cells to send millions of electrochemical impulses along the optic nerve to the brain. The portion of the brain at the back of the head interprets the impulses, enabling us to see the object. The Refraction of Light by the Eye Light entering the eye is first bent, or refracted, by the cornea -- the clear window on the outer front surface of the eyeball. The cornea provides most of the eye's optical power or light- bending ability. After the light passes through the cornea, it is bent again -- to a more finely adjusted focus -- by the crystalline lens inside the eye. The lens focuses the light on the retina. This is achieved by the ciliary muscles in the eye. They change the shape of the lens, bending or flattening it to focus the light rays on the retina. This adjustment in the lens is necessary for bringing near and far objects into focus. The process of bending light to produce a focused image on the retina is called "refraction". Ideally, the light is "refracted" in such a manner that the rays are focused into a precise image on the retina. Many vision problems occur because of an error in how our eyes refract light. -
Clinical Study of Etiopathogenesis of Isolated Oculomotor Nerve Palsy
CLINICAL STUDY OF ETIOPATHOGENESIS OF ISOLATED OCULOMOTOR NERVE PALSY DISSERTATION SUBMITTED TO In partial fulfillment of the requirement for the degree of M.S. DEGREE EXAMINATION OF BRANCH III OPHTHALMOLOGY of THE TAMIL NADU DR. M. G. R MEDICAL UNIVERSITY CHENNAI- 600032 DEPARTMENT OF OPHTHALMOLOGY TIRUNELVELI MEDICAL COLLEGE TIRUNELVELI- 11 APRIL 2015 CERTIFICATE This is to certify that this dissertation entitled “Clinical Study Of Etiopathogenesis Of Isolated Oculomotor Nerve Palsy” submitted by Dr. Saranya.K.V to the faculty of Ophthalmology ,The Tamil Nadu Dr. MGR Medical University, Chennai in partial fulfillment of the requirement for the award of M.S Degree Branch III (Ophthalmology), is a bonafide research work carried out by her under my direct supervision and guidance. Dr. L.D.THULASI RAM MS. (Ortho) Dr A.YOGESWARI. The Dean Professor & Head of the Department Tirunelveli Medical College, Department of Ophthalmology Tirunelveli Tirunelveli Medical College, Tirunelveli. DECLARATION BY THE CANDIDATE I hereby declare that this dissertation entitled “Clinical Study Of Etiopathogenesis Of Isolated Oculomotor Nerve Palsy” is a bonafide and genuine research work carried out by me under the guidance of Dr. RITA HEPSI RANI .M, Assistant Professor of Ophthalmology, Department of Ophthalmology, Tirunelveli Medical College, Tirunelveli Dr. Saranya.K.V Post Graduate In Ophthalmology, Department Of Ophthalmology, Tirunelveli Medical College, Tirunelveli. ACKNOWLEDGEMENT I express my sincere gratitude and thanks to The Dean, Tirunelveli Medical College, Tirunelveli, for providing all the facilities to conduct this study. I sincerely thank Dr.A.Yogeswari Professor and HOD, Dept of Ophthalmology for her valuable advice, comments and constant encouragement for the completion of this study. -
Retinal Anatomy and Histology
1 Q Retinal Anatomy and Histology What is the difference between the retina and the neurosensory retina? 2 Q/A Retinal Anatomy and Histology What is the difference between the retina and the neurosensory retina? While often used interchangeably (including, on occasion, in this slide-set), these are technically not synonyms. The term neurosensory retina refers to the neural lining on the inside of the eye, whereas the term retina refers to this neural lining along with the retinal pigmentthree epithelium words (RPE). 3 A Retinal Anatomy and Histology What is the difference between the retina and the neurosensory retina? While often used interchangeably (including, on occasion, in this slide-set), these are technically not synonyms. The term neurosensory retina refers to the neural lining on the inside of the eye, whereas the term retina refers to this neural lining along with the retinal pigment epithelium (RPE). 4 Q Retinal Anatomy and Histology What is the difference between the retina and the neurosensory retina? While often used interchangeably (including, on occasion, in this slide-set), these are technically not synonyms. The term neurosensory retina refers to the neural lining on the inside of the eye, whereas the term retina refers to this neural lining along with the retinal pigment epithelium (RPE). The neurosensory retina contains three classes of cells—what are they? There are five types of neural elements—what are they? What are the three types of glial cells? The two vascular cell types? --? ----PRs ----Bipolar cells ----Ganglion cells ----Amacrine cells ----Horizontal cells --? ----Müeller cells ----Astrocytes ----Microglia --? ----Endothelial cells ----Pericytes 5 A Retinal Anatomy and Histology What is the difference between the retina and the neurosensory retina? While often used interchangeably (including, on occasion, in this slide-set), these are technically not synonyms. -
Anatomy and Physiology of the Afferent Visual System
Handbook of Clinical Neurology, Vol. 102 (3rd series) Neuro-ophthalmology C. Kennard and R.J. Leigh, Editors # 2011 Elsevier B.V. All rights reserved Chapter 1 Anatomy and physiology of the afferent visual system SASHANK PRASAD 1* AND STEVEN L. GALETTA 2 1Division of Neuro-ophthalmology, Department of Neurology, Brigham and Womens Hospital, Harvard Medical School, Boston, MA, USA 2Neuro-ophthalmology Division, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA INTRODUCTION light without distortion (Maurice, 1970). The tear–air interface and cornea contribute more to the focusing Visual processing poses an enormous computational of light than the lens does; unlike the lens, however, the challenge for the brain, which has evolved highly focusing power of the cornea is fixed. The ciliary mus- organized and efficient neural systems to meet these cles dynamically adjust the shape of the lens in order demands. In primates, approximately 55% of the cortex to focus light optimally from varying distances upon is specialized for visual processing (compared to 3% for the retina (accommodation). The total amount of light auditory processing and 11% for somatosensory pro- reaching the retina is controlled by regulation of the cessing) (Felleman and Van Essen, 1991). Over the past pupil aperture. Ultimately, the visual image becomes several decades there has been an explosion in scientific projected upside-down and backwards on to the retina understanding of these complex pathways and net- (Fishman, 1973). works. Detailed knowledge of the anatomy of the visual The majority of the blood supply to structures of the system, in combination with skilled examination, allows eye arrives via the ophthalmic artery, which is the first precise localization of neuropathological processes. -
Pupils and Near Vision
PUPILS AND NEAR VISION Akilesh Gokul PhD Research Fellow Department of Ophthalmology Iris Anatomy Two muscles: • Radially oriented dilator (actually a myo-epithelium) - like the spokes of a wagon wheel • Sphincter/constrictor Pupillary Reflex • Size of pupil determined by balance between parasympathetic and sympathetic input • Parasympathetic constricts the pupil via sphincter muscle • Sympathetic dilates the pupil via dilator muscle • Response to light mediated by parasympathetic; • Increased innervation = pupil constriction • Decreased innervation = pupil dilation Parasympathetic Pathway 1. Three major divisions of neurons: • Afferent division 2. • Interneuron division • Efferent division Near response: • Convergence 3. • Accommodation • Pupillary constriction Pupil Light Parasympathetic – Afferent Pathway 1. • Retinal ganglion cells travel via the optic nerve leaving the optic tracts 2. before the LGB, and synapse in the pre-tectal nucleus. 3. Pupil Light Parasympathetic – Efferent Pathway 1. • Pre-tectal nucleus nerve fibres partially decussate to innervate both Edinger- 2. Westphal (EW) nuclei. • E-W nucleus to ipsilateral ciliary ganglion. Fibres travel via inferior division of III cranial nerve to ciliary ganglion via nerve to inferior oblique muscle. 3. • Ciliary ganglion via short ciliary nerves to innervate sphincter pupillae muscle. Near response: 1. Increased accommodation Pupil 2. Convergence 3. Pupillary constriction Sympathetic pathway • From hypothalamus uncrossed fibres 1. down brainstem to terminate in ciliospinal centre -
Rapid Evolution of the Visual System: a Cellular Assay of the Retina and Dorsal Lateral Geniculate Nucleus of the Spanish Wildcat and the Domestic Cat
The Journal of Neuroscience, January 1993, 13(l): 208-229 Rapid Evolution of the Visual System: A Cellular Assay of the Retina and Dorsal Lateral Geniculate Nucleus of the Spanish Wildcat and the Domestic Cat Robert W. Williams,’ Carmen Cavada,2 and Fernando Reinoso-Suhrez* ‘Department of Anatomy and Neurobiology, College of Medicine, University of Tennessee, Memphis, Tennessee 38163 and *Departamento de Morfologia, Facultad de Medicina, Universidad Aut6noma de Madrid, 28029 Madrid, Spain The large Spanish wildcat, Fe/is silvestris tartessia, has re- and important topic, it has been difficult to study the process tained features of the Pleistocene ancestor of the modern of brain evolution in any detail. Our approach has been to domestic cat, F. catus. To gauge the direction and magnitude identify a pair of closely related living species,one from a highly of short-term evolutionary change in this lineage, we have conservative branch that has retained near identity with the compared the retina, the optic nerve, and the dorsal lateral ancestral species,and the other from a derived branch that has geniculate nucleus (LGN) of Spanish wildcats and their do- undergone rapid evolutionary change. The recent recognition mestic relatives. Retinas of the two species have the same that evolution and speciationcan occur in short bursts separated area. However, densities of cone photoreceptors are higher by long interludes of stasisprovides a sound theoretical basis in wildcat-over 100% higher in the area centralis-where- for a search for such pairs (Schindewolf, 1950; Eldredge and as rod densities are as high, or higher, in the domestic lin- Gould, 1972; Stanley, 1979; Gould and Eldredge, 1986).