Why A Rare Medical Condition Would've Caused David Bowie To Flunk TBI Testing

David Bowie was renowned for his other worldly artistry and creativity that was way ahead of his time. Part of his stage persona revolved not just around his vivid makeup and incredible gift for music, but also for his magnetic, almost eerie pair of eyes: one clear blue, the other a moody black.

What gave Bowie’s eyes their hypnotic dual colors, and why is this important for your clients with TBI?

Many people mistakenly assume it was caused by heterochromia, a condition in which a person has two different iris colors. It’s hereditary and usually harmless, and the condition is in fact much more common in dogs, cats, and horses.

But Bowie’s case was different. His eyes were the product not of genes but a teenage fistfight that resulted in anisocoria, a condition in which a person’s eyes have different-size pupils.

In the spring of 1962, Bowie got into a fight with his school pal — and, later, lifetime artistic partner — George Underwood. Both of the boys were fond for the same girl, and as the story goes, Underwood wasn’t exactly pleased. In a fit of passion reportedly punched Bowie in his left eye, and Underwood’s fingernail scratched the surface of Bowie’s eyeball, paralyzing the muscles that contract the iris.

When a person with typical, uninjured eyes stumbles into light their pupils contract and become smaller, showing more of their iris. In darkness, the pupils expand and do the opposite to allow as much light in as possible so you can get into bed without tripping over an errant object on the floor. In Bowie’s case, his left pupil remained permanently expanded, leading to his famous pair of blue and black eyes. And despite the fistfight, the boys’ relationship healed: The two became lifelong friends and artistic collaborators, so apparently they were able to move past their teenage scuffle.

The ability to monitor the constriction and dilation of the pupils has been utilized for years by medical professionals in the assessment of patients with brain injury. You've all seen a doctor shine a penlight into a patient's eye and watch to see if the pupil constricts in response to light and then dilates back to normal.

While this is a useful part of a neurologic examination it can be somewhat subjective and also doesn't detect much of the very subtle changes in pupil function that are too fast to be seen by the naked eye.

A technology first developed about 20 years ago called quantitative pupillometry uses high speed cameras to measure the speed at which the pupils constrict, any delay in response, how much they constrict, and how long it takes before the pupils dilate back to normal. As many of these functions take place in a matter of milliseconds this testing gives far more detailed and objective data than what could be seen on a neurologic examination by a doctor.

This is highly relevant to brain injury as we know that dysfunction in the autonomic, or unconscious portion of the nervous system is what can impact pupillary function. Normative data exists that we can compare our patients to, and this test not only helps us confirm the diagnosis of TBI but also can help guide and monitor progress of the treatment we are providing.

As you can see, David Bowie's eyes would have completely thrown this testing for a loop, but fortunately aniscoria is a fairly rare condition that is easily observed on an initial examination of the patient!

If you have a TBI client you feel would benefit from this testing, TBI rehab, or neurology eval, please reach out to Dr. Walker directly at 904-616-1284 or by email at drwalker@flspineandinjury.com.

Our goat at Ethos is the raise the standard of care across the country for patients suffering with concussions and increase the treatment options made available to them.