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The cornea shows an abrasion above the light reflex. There is a spastic miosis due to an antidromic
reflex that travels to the iris from the irritated cornea by way of the trigeminal nerve. An iritis is already
evident in the photo: there is spastic miosis and some inflammatory exudate is already visible on the
inferior pupil margin. This explains the basis of photophobia in an eye with a corneal abrasion even
though the cornea is totally insensitive to light 1. the cornea is abraded 2. Antidromic impulses from the
irritated trigeminal nerve fibers in the cornea travel to the iris 3. These impulses initiate a reaction in
the iris with dilation and leakage of bloodvessels and a spastic miosis 4. the exposure of the injured eye
to light produces a photophobia even though both the cornea and the iris are insensitive to light. The
photophobia results when the light initiates a pupillary reaction in a congested iris with a resultant
iritation of iris nerve fibers. Dilating the pupil with cycloplegics provides the patient relief by
immobilizing the pupil in a dilated state - thus providing relief from pupil reaction to light. Photophobia
is the unpleasant reaction to light. Dazzling is the unpleasant reaction to an excessive amount of light.
Again, to provide relief to a patient with a corneal abrasion (or keratitis) the pupil should be
immobilized by means of cycloplegics. Of course, dark sunglasses will provide additional comfort
through reduced light and thus further reduction in stimuli to the pupil of the reflexly congested,
irritated iris.