1: The Normal Pupil.- I. An Introductory Discussion of Anatomy as It Relates to the Pupil.- A. Anatomy of the Iris Musculature.- B. Efferent Pathways of the Pupil.- C. Afferent Pathway of the Pupillary Light Reflex.- D. Cortico-Pretectal Connections?.- E. Supranuclear Pathway for the Near-Vision Reflex (Pupillary Synkinesis).- II. Pupil Size.- A. Variations of Pupil Size.- B. "Apparent" Pupil Size (Entrance Pupil).- III. Pharmacologic Effects on the Pupil.- A. Locally Administered Pupil-Active Agents.- IV. Reflex Changes in the Pupil.- A. Pupillary Unrest (Pupillary Oscillations).- B. Pupillary Responses to Light.- C. Accommodation-Convergence Synkinesis.- D. The Pupil in Sleep.- E. Psychosensory Reflex Dilation of the Pupil.- F. Stimulation of the Vestibular Apparatus.- G. The Orbicularis Phenomenon.- H. The Trigeminal Reflex.- 2: Examination of the Pupil.- I. Methods and Instrumentation.- A. Methods of Direct Observation.- B. Entoptic Methods.- C. Photographic Methods of Examination.- D. Infrared Reflex Pupillography: The Heidelberg Pupillograph.- E. Electronic Scanning of the Eye (Television Pupillometry).- F. The Pupillogram.- II. Pupillary Light Reflexes in the Evaluation of Retinal Function.- A. Evaluation of Normal Retinal Function.- B. Evaluation of Abnormal Retinal Function.- C. Objective Perimetry.- 3: The Abnormal Pupil.- I. Irregularities of the Pupil.- A. Malformations and Anomalies of the Iris.- B. Progressive Essential Iris Atrophy.- C. Trauma.- D. Tumors of the Iris.- E. Inflammatory Diseases of the Iris.- II. Pupillary Disturbances Accompanying Neuroophthalmologic Diseases.- A. Lesions of the Afferent Pupillary Pathway.- B. Examination and Differential Diagnosis of Afferent Pupillary Disturbances.- C. Lesions of the Midbrain (Involving the Pretecto-Oculomotor Tract).- D. Lesions of the Efferent Pupillary Pathways.- E. Pharmacodynamic Tests for the Differential Diagnosis of Efferent Pupillary Disturbances.- F. Periodic Pupillary Disturbances.- G. Paradoxical Pupillary Reactions.- H. Pupillary Disturbance in Epilepsy.- III. Pupillary Disturbances Due to Poisonings.- A. Poisonings Characterized by Mydriasis.- B. Poisonings Characterized by Miosis.- C. Hippus and Episodic Pupillary Changes Due to Poisonings.- References.
This monograph by Professor Alexandridis continues the proud tradition of German ophthalmology in its discussion of the pupil and its importance in the diagnosis of ocular, neurologic, and systemic diseases. The first encyclopedic work on the pupil was written by Wilbrand and Saenger at the end of the 19th century. This redoubtable pair of physicians collected, analyzed, and clas sified all the material available at that time, bringing order into the previous chaos. The second major work was the book by C. v. Behr shortly after World War 1. At that time, syphilis had been accurately diagnosed with the aid of serologic tests, and pharmacologic effects on the pupil had become well known. The third significant development was initiated before World War II by the neurologist Otto Lowenstein, whose work was later brilliantly continued by his pupil and niece Irene Lowenfeld. The introduction of their clinically useful pupillograph made quantitative analysis possible. There followed a number of important contributions to the knowledge of pupillary physiology and pathology, espe cially by Harms in Tiibingen and Thompson in Iowa City. But the next decisive contribution is this monograph by Alexandridis.
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