Pupillary symptoms in three patients with pandysautonomia

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Abstract
Three cases of pandysautonomia are discussed, with particular emphasis on the pupillary disturbances involved. Pupillary reactions were examined with infrared pupillography. In Case 1, early symptoms included internal ophthalmoplegia of both eyes. Five months later, recovery was complete in the left eye, but incomplete in the right. Cases 2 and 3 showed bilateral or unilateral tonic pupils. Dilatation upon instillation of a low concentration of epinephrine revealed hypersensitive pupil responses in all three cases. The instillation of a low concentration of methacholine resulted in miosis in all cases. These responses suggest that the main lesion was located in the postganglionic fibers of both the sympathetic and parasympathetic neurons of the pupils. They also suggest either that there was recovery from the initial internal ophthalmoplegia or that it changed to tonic pupils at a later stage.