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Clinical examination revealed a high-volume collapsing pulse and a wide pulse pressure. Notably, Landolfi\u2019s sign, alternating pupillary constriction and dilation synchronous with the cardiac cycle, was observed and documented via slit-lamp examination. Transthoracic echocardiography confirmed severe aortic regurgitation (AR) with an eccentric regurgitant jet, a regurgitant fraction of 71%, and a reduced left ventricular ejection fraction of 45%. The patient underwent successful aortic valve replacement with a bioprosthetic valve. This case underscores the significance of recognizing rare ocular signs in the clinical assessment of severe AR.<\/jats:p>","DOI":"10.4103\/aam.aam_268_25","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T12:00:06Z","timestamp":1764072006000},"page":"1006-1008","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["From Eye to Echo: Landolfi Sign as a Clue to Diagnosis of Severe Aortic Regurgitation"],"prefix":"10.4103","volume":"25","author":[{"given":"Hari Lalith Reddy","family":"Kovvuri","sequence":"first","affiliation":[{"name":"Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhileswaran Ayalur","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasudha","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nagendra Boopathy","family":"Senguttuvan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"R1-20260803","doi-asserted-by":"crossref","first-page":"e531","DOI":"10.1016\/j.amjmed.2017.05.045","article-title":"'Landolfi's Sign'- Eyes Don't See what the mind does not know!","volume":"130","author":"Saini","year":"2017","journal-title":"Am J Med"},{"key":"R2-20260803","first-page":"615","article-title":"A new sign of aortic insufficiency: Circulatory Hippus","volume":"90","author":"Landolfi","year":"1909","journal-title":"New York medical journal"},{"key":"R3-20260803","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1167\/iovs.16-20785","article-title":"Origins of pupillary hippus in the autonomic nervous system","volume":"58","author":"Turnbull","year":"2017","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"Suppl 3","key":"R4-20260803","doi-asserted-by":"crossref","first-page":"S96","DOI":"10.1097\/00005344-198500073-00011","article-title":"Control of ocular blood flow","volume":"7","author":"Bill","year":"1985","journal-title":"J Cardiovasc Pharmacol"},{"key":"R5-20260803","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/0042-6989(82)90179-1","article-title":"Pupillary micro movements apparently related to pulse frequency","volume":"22","author":"Daum","year":"1982","journal-title":"Vision Res"},{"key":"R6-20260803","doi-asserted-by":"crossref","first-page":"37","DOI":"10.5114\/ait.2021.104550","article-title":"Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. 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