Pupil response components: Attention-light interaction in patients with Parinaud's syndrome

Covertly shifting attention to a brighter or darker image (without moving one's eyes) is sufficient to evoke pupillary constriction or dilation, respectively. One possibility is that this attentional modulation involves the pupillary light response pathway, which pivots around the olivary pretectal nucleus. We investigate this possibility by studying patients with Parinaud's syndrome, where the normal pupillary light response is strongly impaired due to lesions in the pretectal area. Four patients and nine control participants covertly attended (while maintaining fixation at the center of a monitor screen) to one of two disks located in the left and right periphery: one brighter, the other darker than the background. Patients and control subjects behaved alike, showing smaller pupils when attending to the brighter stimulus (despite no eye movements); consistent results were obtained with a dynamic version of the stimulus. We interpret this as proof of principle that attention to bright or dark stimuli can dynamically modulate pupil size in patients with Parinaud's syndrome, suggesting that attention acts independently of the pretectal circuit for the pupillary light response and indicating that several components of the pupillary response can be isolated - including one related to the focus of covert attention.