Photophobia in a blind patient: an alternate visual pathway

Case report

Amin Amini M.D., M.Sc. 1 , Kathleen Digre M.D. 1 , and William T. Couldwell M.D., Ph.D. 1
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  • 1 Departments of Neurosurgery and Neurology, Division of Neuro-Ophthalmology, Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah
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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.

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Contributor Notes

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: william.couldwell@hsc.utah.edu.
  • 1

    Bergua A, , Schrodl F, & Neuhuber WL: Vasoactive intestinal and calcitonin gene-related peptides, tyrosine hydroxylase and nitrergic markers in the innervation of the rat central retinal artery. Exp Eye Res 77:367374, 2003

    • Search Google Scholar
    • Export Citation
  • 2

    Berson DM, , Dunn FA, & Takao M: Phototransduction by retinal ganglion cells that set the circadian clock. Science 295:10701073, 2002

  • 3

    Blasdel GG, & Lund JS: Termination of afferent axons in macaque striate cortex. J Neurosci 3:13891413, 1983

  • 4

    Callaway EM: Structure and function of parallel pathways in the primate early visual system. J Physiol 566:1319, 2005

  • 5

    Chou TC, , Bjorkum AA, , Gaus SE, , Lu J, , Scammell TE, & Saper CB: Afferents to the ventrolateral preoptic nucleus. J Neurosci 22:977990, 2002

    • Search Google Scholar
    • Export Citation
  • 6

    Croner LJ, & Kaplan E: Receptive fields of P and M ganglion cells across the primate retina. Vision Res 35:724, 1995

  • 7

    Custer PL, & Reistad CE: Enucleation of blind, painful eyes. Ophthal Plast Reconstr Surg 16:326329, 2000

  • 8

    Drummond PD: A quantitative assessment of photophobia in migraine and tension headache. Headache 26:465469, 1986

  • 9

    Eckhardt B, , McClean JM, & Goodell H: Experimental studies on headache: the genesis of pain from the eye. Proc Assoc Res Nerv Ment Dis 23:209227, 1943

    • Search Google Scholar
    • Export Citation
  • 10

    Freedman MS, , Lucas RJ, , Soni B, , von Schantz M, , Munoz M, & David-Gray Z, : Regulation of mammalian circadian behavior by non-rod, non-cone, ocular photoreceptors. Science 284:502504, 1999

    • Search Google Scholar
    • Export Citation
  • 11

    Hubel D: Eye, Brain, and Vision New York, Scientific American Library, 1995

  • 12

    Itoh K, , Takada M, , Yasui Y, & Mizuno N: A pretectofacial projection in the cat: a possible link in the visually-triggered blink reflex pathways. Brain Res 274:332335, 1983

    • Search Google Scholar
    • Export Citation
  • 13

    Kaplan E, & Shapley RM: The primate retina contains two types of ganglion cells, with high and low contrast sensitivity. Proc Natl Acad Sci U S A 83:27552757, 1986

    • Search Google Scholar
    • Export Citation
  • 14

    Kawasaki A, & Purvin VA: Photophobia as the presenting visual symptom of chiasmal compression. J Neuroophthalmol 22:38, 2002

  • 15

    Keane JR: Blinking to sudden illumination. A brain stem reflex present in neocortical death. Arch Neurol 36:5253, 1979

  • 16

    Lamonte M, , Silberstein SD, & Marcelis JF: Headache associated with aseptic meningitis. Headache 35:520526, 1995

  • 17

    Lebensohn JE: Photophobia: mechanism and implications. Am J Ophthalmol 34:12941300, 1951

  • 18

    Liu XB, , Jones EG, , Huntley GW, & Molinari M: Tachykinin immunoreactivity in terminals of trigeminal afferent fibers in adult and fetal monkey thalamus. Exp Brain Res 78:479488, 1989

    • Search Google Scholar
    • Export Citation
  • 19

    Livingstone M, & Hubel D: Segregation of form, color, movement, and depth: anatomy, physiology, and perception. Science 240:740749, 1988

    • Search Google Scholar
    • Export Citation
  • 20

    Lucas RJ, , Douglas RH, & Foster RG: Characterization of an ocular photopigment capable of driving pupillary constriction in mice. Nat Neurosci 4:621626, 2001

    • Search Google Scholar
    • Export Citation
  • 21

    Lucas RJ, , Freedman MS, , Munoz M, , Garcia-Fernandez JM, & Foster RG: Regulation of the mammalian pineal by non-rod, non-cone, ocular photoreceptors. Science 284:505507, 1999

    • Search Google Scholar
    • Export Citation
  • 22

    Matteau I, , Boire D, & Ptito M: Retinal projections in the cat: a cholera toxin B subunit study. Vis Neurosci 20:481493, 2003

  • 23

    Mukuno K, , Aoki S, , Ishikawa S, , Tachibana S, , Harada H, & Hozumi G, : Three types of blink reflex evoked by supraorbital nerve, light flash and corneal stimulations. Jpn J Ophthalmol 27:261270, 1983

    • Search Google Scholar
    • Export Citation
  • 24

    Rushworth G: Observations on blink reflexes. J Neurol Neurosurg Psychiatry 25:93108, 1962

  • 25

    Shankland WE: The trigeminal nerve. Part II: the ophthalmic division. Cranio 19:812, 2001

  • 26

    Shankland WE II: The trigeminal nerve. Part I: an overview. Cranio 18:238248, 2000

  • 27

    Standring S: Gray’s Anatomy: The Anatomical Basis of Clinical Practice ed 39. Philadelphia, Elsevier, 2004

  • 28

    Stringham JM, , Fuld K, & Wenzel AJ: Spatial properties of photophobia. Invest Ophthalmol Vis Sci 45:38383848, 2004

  • 29

    Tackmann W, & Ettlin T: Blink reflexes elicited by electrical, acoustic and visual stimuli. II Their relation to visual-evoked potentials and auditory brain stem evoked potentials in the diagnosis of multiple sclerosis. Eur Neurol 21:264269, 1982

    • Search Google Scholar
    • Export Citation
  • 30

    Trobe JD: Photophobia in anterior visual pathway disease. J Neuroophthalmol 22:12, 2002

  • 31

    van der Horst GT, , Muijtjens M, , Kobayashi K, , Takano R, , Kanno S, & Takao M, : Mammalian Cry1 and Cry2 are essential for maintenance of circadian rhythms. Nature 398:627630, 1999

    • Search Google Scholar
    • Export Citation
  • 32

    Van Gelder RN: Making (a) sense of non-visual ocular photoreception. Trends Neurosci 26:458461, 2003

  • 33

    Van Gelder RN, , Wee R, , Lee JA, & Tu DC: Reduced pupillary light responses in mice lacking cryptochromes. Science 299:222, 2003

  • 34

    Veinante P, , Jacquin MF, & Deschenes M: Thalamic projections from the whisker-sensitive regions of the spinal trigeminal complex in the rat. J Comp Neurol 420:233243, 2000

    • Search Google Scholar
    • Export Citation
  • 35

    Welch KM: Contemporary concepts of migraine pathogenesis. Neurology 61:4 Suppl S2S8, 2003

  • 36

    Welty TE, & Horner TG: Pathophysiology and treatment of subarachnoid hemorrhage. Clin Pharm 9:3539, 1990

  • 37

    Wiberg M, , Westman J, & Blomqvist A: The projection to the mesencephalon from the sensory trigeminal nuclei. An anatomical study in the cat. Brain Res 399:5168, 1986

    • Search Google Scholar
    • Export Citation
  • 38

    Wilson-Pauwels L, , Akesson EJ, & Stewart PA: Cranial Nerves: Anatomy and Clinical Comments Toronto, BC Decker, 1988

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