A case of Adie’s tonic pupil

Abstract

Adie's tonic pupil, the round unilateral tonic pupil, is a neuro-ophthalmologic disorder with dilation and no light response. Although usually idiopathic, it may be associated with infection, inflammation, and postganglionic paraneoplastic nerve damage. It is called Holmes-Adie syndrome when deep tendon reflex loss accompanies Adie’s tonic pupil. The diagnosis is made by observing a miotic response after dilated pilocarpine instillation. Spontaneous recovery depends on etiological factors.

Keywords

• Adie syndrome
• Tonic pupil
• Pilocarpine
• Anisocoria

Adie’nin Tonik Pupillası

Abstract

Adie'nin tonik pupillası; yuvarlak tek taraflı tonik pupilla, genişlemiş ve ışık yanıtı olmayan nöro-oftalmolojik bir bozukluktur. Genellikle idiyopatiktir, ancak enfeksiyon, iltihaplanma ve postganglionik paraneoplastik sinir hasarı ile ilişkilidir. Derin tendon refleks kaybı meydana geldiğinde Holmes-Adie sendromu olarak adlandırılır. Tanı dilate pilokarpin damlatıldıktan sonra gözde miyoz varlığı ile konur. Kendiliğinden düzelmenin gözlenip görülmemesi muhtemelen etiyolojik nedenlere bağlıdır.

Keywords

• Adie sendromu
• tonic pupilla
• pilocarpine
• anisokori

References

1. 1. Adie WJ. Pseudo Argyll-Robertson pupils with absent tendon reflex: a benign disorder simulating tabes dorsalis. Br Med J. 1931;1(3673):928-30.
2. 2. Martinelli P. Tonic pupil and tendon areflexia: the Holmes-Adie’s syndrome. RecentiProg Med. 2001;92(10):605-8.
3. 3. Thompson HS, Hurwitz J, Czarnecki JSC. Aberrant regeneration and the tonic pupil. In: Glaser JS, ed. Neuro-ophthalmology.Vol. 10. St Louis: Mosby; 1980.pp. 100-6.
4. 4. Kanski JJ. Clinical Ophthalmology. 5th ed. Philadelphia: Elsevier; 2003.
5. 5. Bakbak B, Gedik Ş. Anisocoria.Turk J Ophthalmol. 2012; 42(Supplement):68-72.
6. 6. Prasad S. A window to the brain: neuro-ophthalmology for the primary care practitioner. Am J Med. 2018;131(2):120-8.
7. 7. Thompson HS. Adie’s syndrome: some new observations. Trans Am Ophthalmol Soc. 1977;75:587-626.
8. 8. Wilhelm H, Wilhelm B. Diagnosis of pupillary disorders. In: Schiefer U, Wilhelm H, Hart W, eds. Clinical Neuro-Ophthalmology. Berlin: Springer; 2007. pp. 55-69.

9. 9. Kawana K, Okamoto F, Nose H, Oshika T. A case of angle closure glaucoma caused by plateau iris and adie's pupil. Am J Ophthalmol. 2003;135:717.
10. 10. Leibovitch I, Kurtz S, Almog Y. Adie's tonic pupil-induced angle-closure glaucoma. Ophthalmologica. 2002;216:71.