A simple clinical test of pupillary autonomic function: Correlation with cardiac autonomic function tests in diabetes

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Abstract
A simple test of pupillary autonomic function was performed in 175 diabetic patients. The test uses Polaroid photography to measure pupil size in darkness. Small pupils due to dysfunction of the sympathetic innervation were identified in 40 patients. A significant relationship was found between darkness pupil size and three conventional cardiac autonomic function tests. Renal function was assessed from overnight albumin excretion rates and retinopathy status was determined by direct ophthalmoscopy. Pupillary and cardiac autonomic dysfunction correlated significantly with these indicators of renal and retinal dysfunction. This simple, reproducible test of pupillary function is a useful complement to cardiovascular tests in clinical diagnosis of autonomic neuropathy.