Photophobia in a blind patient: an alternate visual pathway

Case report

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✓ Photophobia is a common neurological and ophthalmological symptom that has been associated with a growing number of neurosurgical conditions, especially compressive lesions. The exact signaling pathways and neurophysiological features of the disorder are not well understood; however, data from multiple studies have shown the significance of the trigeminal system and the pretectal nuclei in its pathophysiology. The authors report on a rare case of a blind patient who presented with photophobia without evidence of light perception. They also review the literature and early experimental data in an effort to understand the possible neuronal pathways and structures involved in photophobia.

Article Information

Address reprint requests to: William T. Couldwell, M.D., Ph.D., Department of Neurosurgery, University of Utah School of Medicine, 30 North 1900 East, Suite 3B409, Salt Lake City, Utah 84132. email:

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    Axial (A) and coronal (B) magnetic resonance images with contrast demonstrating a heterogeneously enhancing mass in the sellar and right parasellar regions, extending into the right cavernous sinus and right medial temporal lobe and encasing the right cavernous carotid artery.

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    Schematic representation of the optic pathway (blue arrows) and hypersensitized trigeminal system (red arrows), illustrating the role of each in photophobia. Irritation of any of the V1, V2, or V3 branches of the trigeminal system can hypersensitize the whole trigeminal system. CN = cranial nerve; LGB = lateral geniculate body; nuc. V = nucleus five; SC = suprachiasmatic nucleus; TGG = trigeminal ganglion; VPM = ventral posteromedial nucleus.



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