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Microphthalmia is a congenital disorder in which the globe of the eye is unusually small and structurally disorganized. [2] [4] While the axis of an adult human eye has an average length of about 23.8 mm (0.94 in), a diagnosis of microphthalmia generally corresponds to an axial length below 21 mm (0.83 in) in adults.
The pupil of the human eye can range in size from 2 mm to over 8 mm to adapt to the environment The human eye can detect a luminance from 10 −6 cd/m 2 , or one millionth (0.000001) of a candela per square meter to 10 8 cd/m 2 or one hundred million (100,000,000) candelas per square meter.
Distance PD is the separation between the visual axes of the eyes in their primary position, as the subject fixates on an infinitely distant object. [2] Near PD is the separation between the visual axes of the eyes, at the plane of the spectacle lenses, as the subject fixates on a near object at the intended working distance. [3]
In addition to dilation and contraction caused by light and darkness, it has been shown that solving simple multiplication problems affects the size of the pupil. [11] The simple act of recollection can dilate the size of the pupil, [12] however when the brain is required to process at a rate above its maximum capacity, the pupils contract. [13]
If there is a unilateral small pupil with normal reactivity to light, it is unlikely that a neuropathy is present. However, if accompanied by ptosis of the upper eyelid, this may indicate Horner's syndrome. If there is a small, irregular pupil that constricts poorly to light, but normally to accommodation, this is an Argyll Robertson pupil.
The iris controls the size of the pupil by means of contracting the iris sphincter muscle and/or the iris dilator muscle. The size of the pupils is dependent on many factors (including light, emotional state, cognitive load, arousal, stimulation), and can range from less than 2 mm in diameter, to as large as 9 mm in diameter.
In humans, the average iris diameter is about 11.5 mm, [23] which naturally influences the maximal size of the pupil as well, where larger iris diameters would typically have pupils which are able to dilate to a wider extreme than those with smaller irises. Maximum dilated pupil size also decreases with age.
The main characteristic that distinguishes physiological anisocoria is an increase of pupil size with lower light or reduced illumination, such that the pupils differ in size between the two eyes. At any given eye examination, up to 41% of healthy patients can show an anisocoria of 0.4 mm or more at one time or another.