Efferent pupillary defects are caused by problems of sympathetic or parasympathetic innervation or structural iris changes presenting as anisocoria or impaired pupillary light reaction. This overview describes the diagnostic steps for evaluating efferent pupillary disorders and outlines further steps of work-up.

Uveal melanomas are the most common ma- lignant tumors of the eye. With modern mo- lecular biological diagnostic methods, such as chromosome 3 typing and gene expres- sion analysis, these tumors can be catego- rized into highly aggressive (monosomy 3, class II) and less aggressive forms. This molec- ular biological stratification is primarily im- portant for determining the risk of these tu- mors as no therapy is currently available that is able to prevent or delay metastases. A ran- domized study of patients with a poor prog- nosis (monosomy 3) is currently being car- ried out in order to determine whether a can- cer vaccine prepared from autologous (pa- tient's own) dendritic cells and uveal mela- noma RNA can prevent or delay progression and further metastases of this extremely ag- gressive form of cancer. Inclusion in the uve- al melanoma study, which hopes to provide a potential therapeutic option for patients, is only possible if patients are referred to an in- stitution that is able to manufacture and pro- vide this vaccination before the patient is op- erated on or treated with radiation. Untreat- ed tumor material is necessary for produc- ing the vaccine on an individualized patient basis.