title: Diagnostic approach to pupillary abnormalities.
abstract: OBJECTIVE
  This article presents an overview of the common and various kinds of pupillary disorders that can be encountered in an outpatient setting.
  
  
  RESULTS
  The dorsal midbrain is a site where lesions may produce either an afferent or an efferent pupillary defect. The classic pupillary syndrome secondary to a dorsal midbrain lesion is bilateral light-near dissociation. Another recognized deficit is bilateral mydriasis. Recent reports have documented unilateral mydriasis, unilateral light-near dissociation, and a relative afferent pupillary defect without visual loss in association with lesions of the dorsal midbrain. These are rare syndromes.
  
  
  CONCLUSIONS
  Careful history and examination can often identify and localize the pupillary disorder, as well as guide appropriate evaluation.
authors.forename: Aki K
authors.initials: AK
authors.lastname: Kawasaki
mesh_terms: D000368:Aged; D004525:Efferent Pathways / Q000473:pathology*; D006801:Humans; D008297:Male; D008636:Mesencephalon / Q000473:pathology*; D009460:Neurologic Examination; D009801:Oculomotor Muscles / Q000473:pathology; D011681:Pupil Disorders / Q000175:diagnosis* / Q000209:etiology; D012025:Reflex, Pupillary / Q000502:physiology; D055815:Young Adult
references.citation: Ophthalmology. 2010 Jan;117(1):175-9
references.pmid: 19923003
references.citation: Ophthalmology. 1995 Nov;102(11):1623-7
references.pmid: 9098253
references.citation: Lancet. 2004 Jul 31-Aug 6;364(9432):415; author reply 415
references.pmid: 15288735
references.citation: J Neuroophthalmol. 1998 Sep;18(3):171-5
references.pmid: 9736199
references.citation: Arch Ophthalmol. 2003 May;121(5):744-5
references.pmid: 12742863
references.citation: Arch Ophthalmol. 2010 Nov;128(11):1486-9
references.pmid: 21060053
references.citation: Arch Ophthalmol. 1990 Mar;108(3):384-7
references.pmid: 2310339
references.citation: Am J Ophthalmol. 2006 Oct;142(4):651-9
references.pmid: 17011859
references.citation: Neurology. 2012 Sep 11;79(11):e97
references.pmid: 22965679
references.citation: Brain. 2010 Aug;133(Pt 8):2426-38
references.pmid: 20659957
references.citation: Am J Med. 2010 Feb;123(2):120-1
references.pmid: 20103017
references.citation: Br J Ophthalmol. 2005 Nov;89(11):1442-4
references.pmid: 16234449
references.citation: Ophthalmology. 1998 Feb;105(2):313-21
references.pmid: 9479293
references.citation: Neurosurg Focus. 2007;23(5):E14
references.pmid: 18004962
references.citation: J Headache Pain. 2011 Feb;12(1):105-7
references.pmid: 20862508
references.citation: Curr Opin Ophthalmol. 2011 Nov;22(6):468-71
references.pmid: 21918445
references.citation: Ophthalmologe. 2014 Apr;111(4):376-8
references.pmid: 24046172
references.citation: Eye (Lond). 2013 Mar;27(3):291-8
references.pmid: 23370415
references.citation: Graefes Arch Clin Exp Ophthalmol. 2013 Mar;251(3):809-15
references.pmid: 22965868
references.citation: Pract Neurol. 2012 Dec;12(6):390-1
references.pmid: 23144306
references.citation: Neurology. 2010 Nov 23;75(21):e86-7
references.pmid: 21098401
references.citation: J Neuroophthalmol. 2012 Jun;32(2):132-4
references.pmid: 22622362
references.citation: Cephalalgia. 2011 Feb;31(3):291-5
references.pmid: 20847085