title: Pupillary supersensitivity and visual disturbance in Parkinson's disease.
abstract: This study evaluated pupillary postganglionic autonomic dysfunction and its relationship to visual disturbance in idiopathic Parkinson's disease (PD). Pupillary sensitivity was examined in relation to a parasympathomimetic agent [0.05% pilocarpine hydrochloride (PL)] and to a sympathomimetic agent [0.02% dipivefrine hydrochloride (DPE)] using infrared pupillography in 40 PD patients and 17 age-matched controls. Visual disturbances were evaluated as well, including blurring, photophobia, night blindness and involuntary eyelid closure in response to light. Pupillary supersensitivity to PL and DPE and their relation to visual disturbances were found to be significantly greater in PD patients than in controls (22.3 +/- 15.1 vs. 10.4 +/- 11.4%, P < 0.005, and14.5 +/- 14.5 vs. 4.9 +/- 8.7%, P < 0.01, respectively). In addition, pupillary sympathetic supersensitivity did not correlate with a reduction of 123I-metaiodobenzylguanidine (MIBG) cardiac accumulation. Patients with PD reported more blurred vision (P < 0.001) and involuntary eyelid closure in response to light (P < 0.05) than controls. Patients with supersensitivity to both PL and DPE complained more often of blurred vision than patients without supersensitivity (P < 0.05). Pupillary sensitivity to PL correlated significantly with a summed score for visual disturbance (P < 0.05, r = 0.417), but DPE sensitivity did not. PD patients have both parasympathetic and sympathetic postganglionic impairments affecting the pupil. Our findings demonstrate that parasympathetic dysfunction contributes significantly to visual disturbance in PD.
authors.affiliation: Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Hori
authors.forename: Motoko
authors.initials: M
authors.lastname: Takamori
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hirayama
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Watanabe
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Nakamura
authors.forename: Fumitada
authors.initials: F
authors.lastname: Yamashita
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ito
authors.forename: Naoki
authors.initials: N
authors.lastname: Mabuchi
authors.forename: Gen
authors.initials: G
authors.lastname: Sobue
mesh_terms: D000367:Age Factors; D004837:Epinephrine / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D008916:Miotics; D009184:Mydriatics; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology*; D010862:Pilocarpine; D011680:Pupil / Q000187:drug effects*; D012737:Sex Factors; D014786:Vision Disorders / Q000150:complications / Q000175:diagnosis*
chemical_list: D008916:Miotics; D009184:Mydriatics; D010862:Pilocarpine; C015173:dipivefrin; D004837:Epinephrine