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Adie's pupil

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Adies pupil
Adies pupil

Other names

Holmes-Adie syndrome (HAS)

Introduction

Adie's pupil is a neurological disorder affecting the pupil of the eye and the autonomic nervous system.

Clinical features

It is characterized by one eye with a pupil that is larger than normal and constricts slowly in bright light (tonic pupil), along with the absence of deep tendon reflexes, usually in the Achilles tendon.

Pathophysiology

HAS is thought to be the result of a neurotrophic (acting on neurons, or nerve cells) viral infection that causes inflammation and damage to neurons in the ciliary ganglion, an area of the brain that controls eye movements, and the dorsal root ganglion, an area of the spinal cord involved in the response of the autonomic nervous system.

Progression

HAS begins gradually in one eye, and often progresses to involve the other eye.

Clinical features

At first, it may only cause the loss of deep tendon reflexes on one side of the body, but then progress to the other side. The eye and reflex symptoms may not appear at the same time. People with HAS may also sweat excessively, sometimes only on one side of the body.

Diagnosis

The combination of these 3 symptoms – abnormal pupil size, loss of deep tendon reflexes, and excessive sweating – is usually called Ross’s syndrome, although some doctors will still diagnose the condition as a variant of HAS.

Cardiovascular involvement

Some individuals will also have cardiovascular abnormalities.

Associated conditions

The HAS symptoms can appear on their own, or in association with other diseases of the nervous system, such as Sjogren’s syndrome or migraine.

Sex differences

It is most often seen in young women.

Inheritance

It is rarely an inherited condition.

Prognosis

  • Holmes-Adie syndrome is not life-threatening or disabling.
  • The loss of deep tendon reflexes is permanent.
  • Some symptoms of the disorder may progress.
  • For most individuals, pilocarpine drops and glasses will improve vision.

Treatment

  • Doctors may prescribe reading glasses to compensate for impaired vision in the affected eye, and pilocarpine drops to be applied 3 times daily to constrict the dilated pupil.
  • Thoracic sympathectomy, which severs the involved sympathetic nerve, is the definitive treatment for excessive sweating.

Latest research - Adie's pupil

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External links

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ICD codes

 

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