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Fifty-six patients with cysticercosis and neuro-ophthalmic signs were examined by me during an 11-year period. Their symptoms generally reflected increased intracranial pressure caused by hydrocephalus, subacute meningitis, cerebral masses or a combination of these effects. Papilledema (37 patients) was the commonest sign, with pupillary abnormalities (16 patients) and nystagmus (12 patients) frequently encountered. Cysticercosis is a relatively benign, although episodic, disease, as long as secondary obstructive hydrocephalus is promptly diagnosed and treated by CSF shunting procedures.

The visual acuity of 100 patients between the ages of 16 and 66 years, seen for routine ophthalmologic examination, was measured before and after dilation. All patients had a predilation visual acuity of 20/40 or better. Postdilation binocular visual acuity using the patients' usual correction was measured first in the office and then outdoors, both with the patient's back to and the patient facing the sun, with and without the aid of postmydriatic sunglasses. Twelve percent experienced disabling photophobia even with the use of postmydriatic sunglasses, with 3% having significant objective visual loss defined as 20/50 or worse. No objective visual loss was found in 30 controls examined outdoors before dilation, without sunglasses. We recommend that patients who have experienced significant photophobia with dilation in the past, or who have never before undergone dilation, make arrangements for transportation after a dilated examination.

The presence of pupillary constriction to darkness is said to be a useful indicator of retinal disease. However, it is also associated with optic nerve disease. The phenomenon has been reported in patients with congenital stationary nightblindness, congenital achromatopsia, bilateral optic neuritis, and dominant optic atrophy. We have observed this response in additional disorders, including anomalies of the optic nerve development, congenital nystagmus, and a variety of diseases affecting the retina. Notably, four of our patients with strabismus and amblyopia, but without apparent retinal or optic nerve disease, have also demonstrated this paradoxic pupil response. While the mechanism for pupillary constriction to darkness remains unclear, the finding of this response in patients without retinal or optic nerve abnormalities questions its value as a localizing sign.

Twenty patients with melanocytoma of the optic disc underwent Goldmann perimetry and pupillary evaluation. Two patients (10%) had normal visual fields. Three (15%) had minimal blind spot enlargement. Fifteen patients (75%) had a greatly enlarged blind spot, of which ten had concomitant nerve fiber bundle field defects. These consisted of a nasal step in two cases (10%), relative nerve fiber bundle defects in four cases (20%), and an absolute arcuate defect in four cases (20%). The blind spot enlargement relates to the pigmented tumor extended beyond the disc boundary, thereby shading the peripapillary retina. The nerve fiber bundle defects result from injury to the visual axons passing through the nerve head, although the mechanism is uncertain. A Marcus Gunn pupillary sign produced by the melanocytoma was found in six patients (30%), all of whom had a substantial relative or absolute nerve fiber bundle defect.