Emerging order of anomalous eye movements with progressive drowsiness

It has been widely recognized that human alertness is reflected in the eyes (e.g., when drowsiness, miosis, slow saccades, divergence, less compensatory vestibulo-ocular reflex, and less-accurate optokinetic response and smooth pursuit emerge). Previous studies that discovered these pupil/oculomotor anomalous behaviors along with lowering alertness evaluated only one or a few of them simultaneously, thus their emergence order is yet unknown. Presently, we focused on the following five pupil/oculomotor behaviors that can be evaluated under a natural stationary environment without giving external sensory stimulations: saccades, slow-phase eye movements, vergence, pupil diameter, and blinks. We demonstrate that their anomalous behaviors emerge in the following order: first: frequent saccades; second: slow saccades; third: divergence & miosis, then slow eye movement, while elongated eyelid closure duration emerges randomly in this sequence. These results provide a basis for the oculo-pupillometry-enabling objective monitoring of progressive drowsiness.