This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
To the Editor.
—I would like to take issue with Goldberg et al's interpretation of the topical 2.5% methacholine test, as given in their article entitled, "Ophthalmologic Studies of Familial Dysautonomia" (80:732-743 [Dec] 1968). Topical 2.5% methacholine instilled in an eye with an intact corneal epithelial barrier does not cause pupillary constriction in the normal eye, and does cause pupillary constriction in the parasympathetically denervated iris (Adie's).However, in patients with familial dysautonomia, the corneal epithelial barrier is not normal. The effect of both the alacrimia and the corneal anesthesia is to break down the corneal epithelial barrier, and, therefore, allow greater penetration of topical medications. Thus, 2.5% methacholine, if it penetrates easily, can cause constriction of the normally innervated pupil, and, therefore, cannot be unequivocably interpreted as indicating sphincter denervation in familial dysautonomia.This is borne out further by several facts:
The pupil in familial dysautonomia does
Gay AJ. COMMENTS ON GOLDBERG ET AL'S ARTICLE IN DECEMBER 1968 ISSUE. Arch Ophthalmol. 1969;81(4):601. doi:10.1001/archopht.1969.00990010603030
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: