Evidence for a neuropathic aetiology in the small pupil of diabetes mellitus.

Infrared television pupillometry was performed on 34 insulin-treated diabetic patients and 55 healthy subjects. Sixteen of the diabetic patients had pupils that failed to dilate normally in darkness. The occurrence of a small pupil was associated with cardiac vagal dysfunction and somatic sensory loss. The small pupil was found to be supersensitive to the mydriatic effect of topical 2% phenylephrine but normally sensitive to 0.5% hydroxyamphetamine eyedrops. It is concluded that the failure of the pupil to dilate in darkness in some diabetic patients is due to neuropathy of the sympathetic innervation.

[1]  S. Smith,et al.  An increased effect of pilocarpine on the pupil by application of the drug in oil. , 1978, The British journal of ophthalmology.

[2]  W. Shain,et al.  Electrophysiology and pharmacology of striated muscle fibres cultured from dissociated neonatal rat pineal glands , 1979, The Journal of physiology.

[3]  J. Pirart.  [Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973 (3rd and last part) (author's transl)]. , 1977, Diabete & metabolisme.

[4]  P. R. Bourne,et al.  Dynamics of the light reflex and the influence of age on the human pupil measured by television pupillometry [proceedings]. , 1979, The Journal of physiology.

[5]  S. Smith,et al.  Heart rate variability in healthy subjects measured with a bedside computer-based technique. , 1981, Clinical science.

[6]  C. A. Clapp.  Diabetic Iridopathy. , 1944, Transactions of the American Ophthalmological Society.

[7]  S. Uga,et al.  Ultrastructure of iris muscles in diabetes mellitus. , 1977, Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde.

[8]  P. Sönksen,et al.  MICRO-COLUMN METHOD FOR HbA1 DETERMINATION , 1980, The Lancet.

[9]  U. Trendelenburg.  Supersensitivity and subsensitivity to sympathomimetic amines. , 1963, Pharmacological reviews.

[10]  V. Ohrt.  Diabetic iridopathy. Clinical studies of the pigment layer of the iris, pupillary function and rubeosis iridis in diabetic patients. , 1968, Danish medical bulletin.

[11]  N. Legg.  Neurotransmitter systems and their clinical disorders , 1978 .

[12]  P. Turner,et al.  The interactions of local guanethidine and sympathomimetic amines in the human eye. , 1969, Archives of ophthalmology.

[13]  P. Low,et al.  The sympathetic nervous system in diabetic neuropathy. A clinical and pathological study. , 1975, Brain : a journal of neurology.

[14]  A. Korczyn,et al.  Sympathetic pupillary tone in old age. , 1976, Archives of ophthalmology.

[15]  Thompson Hs.  Diagnosing Horner's syndrome. , 1977 .

[16]  A. Korczyn.  Adrenergic denervation supersensitivity. , 1975, Advances in neurology.

[17]  W. Maloney,et al.  Evaluation of the causes and accuracy of pharmacologic localization in Horner's syndrome. , 1980, American journal of ophthalmology.

[18]  B. Schwartz.  Current concepts in ophthalmology. , 1978, The New England journal of medicine.

[19]  Smith Sa,et al.  Dynamics of the light reflex and the influence of age on the human pupil measured by television pupillometry [proceedings]. , 1979 .

[20]  L. Iversen,et al.  The inhibition of noradrenaline uptake by sympathomimetic amines in the rat isolated heart. , 1965, British journal of pharmacology and chemotherapy.

[21]  P. Sönksen,et al.  Pupillary signs in diabetic autonomic neuropathy. , 1978, British medical journal.