Pupil size and pupillary light reflex in early infancy: heritability and link to genetic liability to schizophrenia
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Updated: Oct 9, 2025

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Published on: January 6, 2023
Ana Maria Portugal1, Mark J Taylor2, Charlotte Viktorsson3
1Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
Insights
Pupil size and light reflex in infants are highly heritable and genetically independent. Infant pupil size is linked to genetic risk for schizophrenia, offering insights into early markers for later psychiatric conditions.
Area of Science:
- Developmental Psychology
- Psychiatric Genetics
- Neuroscience
Background:
- Pupillometry measures, including pupillary light reflex (PLR) and baseline pupil size, reflect neural circuit activity.
- Atypical pupillary responses are observed in psychiatric and neurodevelopmental conditions.
Purpose of the Study:
- Investigate genetic and environmental contributions to infant pupil size and PLR.
- Examine associations between infant pupillary measures and genetic risk scores for neurodevelopmental and mental health conditions.
Main Methods:
- Twin study design with 510 infant twins (281 MZ, 229 DZ) at 5 months.
- Utilized pupillometry for baseline pupil size and PLR measurements.
- Applied genome-wide polygenic scores (GPSs) for autism, ADHD, bipolar disorder, major depressive disorder, and schizophrenia.
Main Results:
- High heritability for infant pupil size (h²=.64) and PLR (h²=.62).
- Substantial genetic independence between pupil size and PLR (rG=.38).
- Significant positive association between infant tonic pupil size and schizophrenia GPS (β=.15, p=.024).
Conclusions:
- Infant pupillary measures are highly heritable with independent genetic influences.
- Early infant pupil size shows genetic links to schizophrenia risk.
- Pupillometry in genetically informed infant studies can illuminate early physiological markers for later-onset psychiatric disorders.
Background:
Measures based on pupillometry, such as the pupillary light reflex (PLR) and baseline pupil size, reflect physiological responses linked to specific neural circuits that have been implicated as atypical in some psychiatric and neurodevelopmental conditions.
Methods:
We investigated the contribution of genetic and environmental factors to the baseline pupil size and the PLR in 510 infant twins assessed at 5 months of age (281 monozygotic and 229 dizygotic pairs), and its associations with common genetic variants associated with neurodevelopmental (autism spectrum disorder and attention deficit hyperactivity disorder) and mental health (bipolar disorder, major depressive disorder and schizophrenia) conditions using genome-wide polygenic scores (GPSs).
Results:
Univariate twin modelling showed high heritability at 5 months for both pupil size (h2 = .64) and constriction in response to light (h2 = .62), and bivariate twin modeling indicated substantial independence between the genetic factors influencing each (rG = .38). A statistically significant positive association between infant tonic pupil size and the GPS for schizophrenia was found (β = .15, p = .024), while there was no significant association with the GPS for autism or any other GPSs.
Conclusions:
This study shows that some pupil measures are highly heritable in early infancy, although substantially independent in their genetic etiologies, and associated with common genetic variants linked to schizophrenia. It illustrates how genetically informed studies of infants may help us understand early physiological responses associated with psychiatric disorders which emerge much later in life.
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