Parasympathetic denervation of the iris in alcoholics with vagal neuropathy.

Abstract

SUMMARY Parasympathetic innervation of the pupil was studied in 30 alcoholics. Twelve alcoholics had cardiac vagal neuropathy. The resting pupillary diameters in this group were larger, and pupil reponses to methacholine were greater, than in control subjects or alcoholics without vagal neuropathy. These observations imply that lesions in the parasympathetic supply to the pupil may occur in alcoholics with other evidence of autonomic neuropathy involving the parasympathetic system.Parasympathetic neuropathy involving the vagus nerve was reported in 1974 from neuropathological studies of four alcoholic patients. ' We have recently shown' that evidence of vagal neuropathy may also be obtained during life and that this is not uncommon in alcoholic subjects with other evidence of moderate to severe nervous damage. However, a study of the parasympathetic supply to the pupil in alcoholic subjects showed no evidence of denervation, with 8% each of alcoholics' and control subjects showing pupillary constriction of 1 mm or greater with methacholine.' Patients in that study had relatively mild nervous damage. with only 40% having peripheral neuropathy and no patients having vagal neuropathy as determined from the heart rate responses to Valsalva's manoeuvre. It remained to be determined whether, in alcoholics with vagal neuropathy, the third cranial nerve may also be affected. This was the purpose of the present study. Parasympathetic denervation of the pupil was tested by measuring the resting pupil diameter and by examining the supersensitivity of the pupil to topical administration of dilute methacholine. Photographic studies A 2% solution of methacholine in normal saline ("Mecholyl", acetyl-f3-methylcholine) was used for the pupillary test. The solution was freshly prepared monthly by the Wellington Hospital Pharmacy, sterilised by the method of filtration and kept stored at 4°C. The study was carried out in a photographic studio under standard lighting conditions. The ambient light was kept moderate and constant. A studio flash unit (timing 1/60th second, exposure f 11-0) was positioned at a far corner of the room. The subject sat behind a head-rest on which he rested his chin to obtain constant and reproducible positions. Photographs were taken of the eyes with a vertical scale (ruled in centimetres) positioned close to and in the plane of the eyes. The camera used was a Nikon F2 35 mm single lens reflex camera with a 105 mm lens. Two drops of 2% methacholine were instilled in both eyes which then were closed for 30 seconds, during which time a gentle pressure was applied on the lacrimal duct to delay drainage of fluid. Twenty minutes after instillation of the drug, photographs were again taken of the eyes. Enlarged prints of the eyes and the scale were made from the exposures. The pupil diameters (measured in the horizontal plane) were measured blind by three observers using the centimetre scale on the prints, with an accuracy of ±0-1 mm. The three readings for each pupil were averaged. The constriction of a pupil...

Influence of chronic alcohol abuse and ensuing forced abstinence on static subjective accommodation function in humans

“…Such alterations could have an impact on binocular measures of accommodation (Miller et al, 1985(Miller et al, , 1986. As noted in the introduction, a number of investigators have considered whether chronic alcohol consumption could cause a peripheral neuropathy, and have made studies on the pupil or its re¯exes (Skogland, 1943;Schleyer and Wichmann, 1961;Myers et al, 1979;Rubin et al, 1980;Tan et al, 1984;Miralles et al, 1995). Schleyer and Wichmann (1961) could ®nd no consistent effect of BAL (0.6±2.4 mg/%) on pupil diameter, but do not provide details (e.g.…”

“…A neurological basis to the effects of chronic excessive alcohol consumption (i.e. more than 21 units/week) has been explored by assessment of pupillary function (Skogland, 1943;Schleyer and Wichmann, 1961;Brown et al, 1977;Myers et al, 1979;Rubin et al, 1980;Tan et al, 1984;Miralles et al, 1995) or corneal sensitivity (Goldberg, 1943). The results of such studies have also been inconclusive, perhaps as a result of the various control groups not being well de®ned.…”

The use of pupillometry in the assessment of cardiac autonomic function in elite different type trained athletes

“…Moreover, the circuitous involvement of a large number of neural pathways in controlling the iris makes the pupil a rich source of information (Barbur 2004 Pupillometry is proved to be a useful tool in medical research and reveals the sub-clinical defects in autonomic function of various diseases (Fotiou et al 2007). Assessment of pupil reXex has previously been used in patients with heart failure (Keivanidou et al 2010), diabetes (Hreidarsson and Gundersen 1985;Piha and Halonen 1994), Parkinson's disease (Stergiou et al 2009), Alzheimer's disease (Fotiou et al 2000a, b), Myasthenia gravis (Tsiptsios et al 2008), alcoholism (Tan et al 1980), anxiety (Nagai et al 1980), depression (Sokolski and Demet 1996), Down's syndrome (Sacks and Smith 1989) and mental retardation (Chaney et al 1989). Pupillometry is further used in the investigation of central autonomic pathways , lateralization (Bär et al 2005), alertness or anxiety (Bitsios et al 2004), in Pavlonian conditioning (Reinhard et al 2006), cognitive ability (Verney et al 2004), memory load (Van Gerven et al 2004), attention (Karatekin 2004) and in the study of temporal orientation (Nuthmann and Van Der Meer 2005).…”

Automated standardized pupillometry with optical method for purposes of clinical practice and research

“…Assessment of the pupil reflex has been used to study the deficit of the parasympathetic supply to the pupil in alcoholics (Tan et al ., 1984), diabetic patients (Eustace et al ., 1981; Chapman et al ., 1999), AIDS patients (Maclean & Dhillon, 1993), Down’s syndrome (Chaney et al ., 1989), depression (Sokolski & Demet, 1996; Fountoulakis et al ., 1999), generalized anxiety disorder (Bakes et al ., 1990), drug abuse (Grünberger et al ., 1990; Rosse et al ., 1995), mental retardation (Sacks & Smith, 1989) and Alzheimer’s disease (Idiaquez et al ., 1994; Scinto et al ., 1994; Loupe et al ., 1996; Kurz et al ., 1997; Prettyman et al ., 1997; Fotiou et al ., 1998; Fotiou et al ., 2000), and also to elucidate the mode of action of specific anti‐depressants (Szabadi et al ., 1980; Shur & Checkley, 1982; Bourne et al ., 1993; Theofilopoulos et al ., 1995).…”