![]() All of the selected articles were published in peer-reviewed journals, and public doctorate dissertations were also cited when appropriate. Google scholar and the SUNY College of Optometry library resources were also searched in a similar manner. In performing the review, Pubmed Central/National Library of Medicine databases were searched for pertinent articles using any combination of the terms: mild traumatic brain injury, mTBI, concussion, pupil, pupillometry, infrared pupillometry, blast versus blunt injury, pediatric mTBI, vision deficits, photosensitivity and other appropriate keywords discussed under the various headings in the paper. ![]() ![]() Recently, with the availability of modern pupillometers, the clinician and researcher now have the ability to assess subtle abnormalities in steady-state pupil size and dynamics of the direct and consensual pupillary responses. Clinically, abnormal pupil size and responsivity provide important clues to detect the site and nature of various lesions along its extensive afferent and efferent pathways. The pupils are routinely studied by clinicians to assess, in part, the neural integrity of the visual system. However, the visual dysfunction relevant to the present review is that of the pupillary light reflex (PLR). More specifically, it may produce a constellation of visual problems of a sensory (e.g., reduced contrast sensitivity, visual field deficits), motor (e.g., vergence dysfunction, saccadic dysmetria) and/or perceptual (e.g., impaired distance perception, difficulty with figure–ground discrimination) nature. For example, there may be problems with impulse control, sleep, attention and memory, to name a few. In addition, this pervasive brain injury results in a constellation of general medical problems of a sensory, motor, perceptual, cognitive, attentional, physical, physiological and/or behavioral nature. This is especially the case for the white matter tracts, which become stretched/deformed and at times broken leading to neural signal processing errors, distortions and delays. The resultant injury to the brain and surrounding microenvironment, frequently being of a coup–contrecoup nature, produces widespread neural damage. There are approximately 1.8 million mTBIs in the USA annually, primarily from motor vehicle accidents, falls and sports/recreational accidents, with perhaps up to 10 million worldwide. This was primarily as a result of the USA’s recent military encounters in Iraq and Afghanistan, where TBI was the ‘signature injury’ and frequently the ‘invisible injury’, as well as from the sports arena, in particular football with its potential link to chronic traumatic encephalopathy. The area of mTBI has been in the forefront of the medical world for more than a decade. The pupil may also be a window to mild traumatic brain injury (mTBI). Some believe that the pupil is the window to the soul.
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