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If there is an efferent defect in the left eye, the left pupil will remain dilated regardless of where the light is shining, while the right pupil will respond normally. If there is an afferent defect in the left eye, both pupils will dilate when the light is shining on the left eye, but both will constrict when it is shining on the right eye.
If there is a unilateral small pupil with normal reactivity to light, it is unlikely that a neuropathology 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, which is a sign of tertiary syphilis.
When other errors of refraction, such as hypermetropia and astigmatism, believed to be congenital, were present, it has been supposed that the accommodative struggle for distinct vision produced irritation and strain which encouraged the production of short 1 A satisfactory explanation of the mechanism by which near work produces myopia has not yet been given. As to whether the same thing happens among primitive people or people living under primitive conditions, very little information is available. They are also benefited by mental shifting (see Chapter XV) from.
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