![]() ![]() We used a paired-eye control study design with three cohorts receiving either 1.0% tropicamide (PNS antagonist) in light (TL), 1.0% tropicamide in dark (TD), or 10% phenylephrine (SNS) in light (PL), n = 12 in each. Ayurvedic healers also use it to treat a cold or fever.The purpose of this study was to determine the relative roles of the sympathetic (SNS) and parasympathetic nervous system (PNS) in pupillary hippus. In traditional Chinese medicine, practitioners prescribe aconite to cure lack of energy and coldness, so-called yang deficiency. Hippus may also be a sign of aconite, or monkshood, poisoning. Abnormally small pupils may indicate the use of narcotics, abnormally dilated pupils may indicate the use of cocaine, and hippus may indicate the use of sedatives. When law enforcement officers make stops for suspected Driving under the influence (DUI) behavior, they will routinely check the pupils for abnormal pupil size or oscillation. Pentobarbital, phenobarbital, butalbitol and thiopental are some of the common medications that patients take for medicinal or recreational purposes that may cause the condition. Hippus occurs when a patient has used one of the barbiturate drugs. ![]() In addition to controlling pupil size, the autonomic nervous system controls heart rate, salivation, urination, breathing, and organ function. Patients with imbalances of the autonomic nervous system also develop pupillary athetosis. An oscillating pupil can also occur in conjunction with a total palsy of the third cranial nerve, the oculomotor nerve, which disrupts the nerve supply to the muscles that move the pupil and the eye, itself. Researchers have associated hippus with various diseases, including multiple sclerosis, neurosyphilis, myasthenia gravis, and cerebral tumors. For this reason, pupillary athetosis in hospital patients may put them at a higher risk of premature death. Hippus was an additional independent risk factor that statistically elevated risk of death even in the absence of the other factors. The probability of dying within 30 days rose when the patients had a change in mental status, kidney disease, cirrhosis of the liver, and a history of trauma. Patients who exhibited hippus experienced a greater chance of dying over the following 30 days than the control patients. Researchers have analyzed the cases of hospitalized patients with established hippus to compare with patients without hippus. In rare incidences, however, this form of pupillary variability may point to a systemic disease or toxicity, which may be life threatening. Physicians consider hippus a normal variation in pupil reaction, and in most cases, hippus does not imply an underlying disease or defect. Pupils dilate when a subject feels excited or emotionally aroused. Normally, pupils constrict when an examiner beams a light into the eye or when the patient focuses on a near object. Hippus, also known as pupillary athetosis, is a spasmodic, repetitive oscillation in the pupil size, with alternating constriction and dilation of the pupil diameter about 1 to 2 millimeters (0.03 to 0.07 inches) every five seconds, without relation to the intensity of ambient lighting, emotions of the patient, or focal length of the patient. ![]()
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