Irregular pupil cycling as a characteristic abnormality in patients with demyelinative optic neuropathy

We used an infrared videopupillometer combined with an electronic circuit that regulated the retinal light level as a function of pupil area to assess the regularity of pupil cycling in normal subjects and in patients with known abnormalities in the pupil light reflex pathways. The light stimulus was turned on whenever pupil area exceeded a preset value. Two types of abnormalities were observed for patients with demyelinative optic neuropathy: a failure of the pupil to cycle despite a preserved pupillary response to a single light pulse; and, for those patients in whom cycling was possible, a characteristic intermittent irregularity in the amplitude of pupil cycling. These abnormalities were not seen in normal subjects or in patients with ischemic optic neuropathy, surgical lesions involving the optic chiasm, Adie's syndrome, or Horner's syndrome.