Presentation
Our case, only the second ever reported, emphasizes the importance of considering the diagnosis of neurosyphilis in patients presenting with an isolated acute tonic pupil. [ncbi.nlm.nih.gov]
The authors present a case of a 10-year-old girl who was referred with abnormal pupils and complained of headaches. [healio.com]
Eyes
- Anisocoria
The difference in pupil size (anisocoria) can be found in a variety of ophthalmic disorders, which may be benign or not, such as physiological anisocoria, Horner’s syndrome, Adie’s pupil, pharmacological anisocoria, pupillary supranuclear disorders, problems [scielo.br]
The clearest difference found was in the degree of anisocoria, particularly in the light: patients with Adie/Ross syndrome are much more likely to have significant anisocoria compared with patients with a generalised neuropathy. [ncbi.nlm.nih.gov]
- Blurred Vision
She complained of blurred vision and headache mainly while reading. She had a 35-year history of hepatitis B and liver cirrhosis. [ncbi.nlm.nih.gov]
She reported few episodes of blurring of vision in her right eye in the recent few months. On one of the routine follow-up visits, right intraocular pressure (IOP) was 70 mm Hg and on gonioscopy the angle was closed 360°. [karger.com]
- Pupillary Abnormality
This pupillary abnormality may result from ischaemia of the ciliary ganglia. [ncbi.nlm.nih.gov]
[…] pupil Right tonic pupil Right tonic pupillary reaction Tonic pupil Tonic pupil, both eyes Clinical Information A pupillary abnormality characterized by a poor pupillary light reaction, reduced accommodation, iris sector palsies, an enhanced pupillary [icd9data.com]
A pupillary abnormality characterized by a poor pupillary light reaction, reduced accommodation, iris sector palsies, an enhanced pupillary response to near effort that results in a prolonged, "tonic" constriction, and slow pupillary redilation. [lookfordiagnosis.com]
[…] encyclopedia of medical concepts ψ ψ ψ Tonic Pupil More information in Books or on Definition : A pupillary abnormality characterized by a poor pupillary light reaction, reduced accommodation, iris sector palsies, an enhanced pupillary response to near [reference.md]
Neurologic
- Headache
She complained of blurred vision and headache mainly while reading. She had a 35-year history of hepatitis B and liver cirrhosis. [ncbi.nlm.nih.gov]
The authors present a case of a 10-year-old girl who was referred with abnormal pupils and complained of headaches. [healio.com]
Indicates damage of ciliary ganglion. (1 pupil non-reactive to light) Differentials Posterior Synechiae Acute Angle Closure Tadpole Pupils (irregular shape pupils associated with headaches) Bitemporal Sphincter Palsy (vertically oriented pupils from OIS [odpalace.com]
Workup
Ocular Mass/Retrobulbar Mass PRP Systemic Diabetes Mellitus Syphillis Sarcoid Lyme Disease Characteristics Onset 20-40 years old, predominantly female (If Idiopathic) Associated Symptoms Diminished corneal sensitivity Decreased deep tendon reflexes Workup [odpalace.com]
Anisocoria workup repeated 2 weeks after the initial diagnosis of an acute right Adie's tonic pupil. a Pupils in the light. b Pupils on convergence. c Reversal of anisocoria 30 min after instillation of one drop of dilute pilocarpine (0.125%) in each [ncbi.nlm.nih.gov]
[…] asymmetric, and these pupils are typically very difficult to dilate, which can help confirm the diagnosis. 15 Because of the association with chronic syphilis, systemic laboratory testing, including FTA-Abs and VDRL, should be included in these patients’ workup [reviewofoptometry.com]
[…] headache Base of skull/carotid canal – tumor (nasopharyngeal CA) – trauma Middle ear – tumor (cholesteatoma) – infection Cavernous sinus – tumor (pituitary adenoma) – inflammation (Tolosa Hunt) – cavernous carotid aneurysm – thrombosis – fistula – further workup [lifeinthefastlane.com]
Treatment
With appropriate treatment, the prognosis of Adie Syndrome is good Please find comprehensive information on Adie Syndrome regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis [dovemed.com]
The usual treatment of a standardised Adie syndrome is to prescribe reading glasses to correct for impairment of the eye(s). Pilocarpine drops may be administered as a treatment as well as a diagnostic measure. [en.wikipedia.org]
She went to the otorhinolaryngologist, where she was diagnosed with Meniere’s Syndrome, and she began treatment with Labirin® (betahistine dihydrochloride). She abandoned treatment after developing headache as a side effect of the drug. [scielo.br]
Is there any 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. [web.archive.org]
What is Traumatic Iritis: Causes, Symptoms, Treatment, Pathophysiology, Prognosis, Complications [epainassist.com]
Prognosis
With appropriate treatment, the prognosis of Adie Syndrome is good Please find comprehensive information on Adie Syndrome regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention, prognosis [dovemed.com]
Pilocarpine drops may be administered as a treatment as well as a diagnostic measure, and should be applied three times daily.[1] Thoracic sympathectomy is the definitive treatment of diaphoresis, if the condition is not treatable by drug therapy.[1] Prognosis [eyecare-information-service.org.uk]
What is the 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. [web.archive.org]
What is Traumatic Iritis: Causes, Symptoms, Treatment, Pathophysiology, Prognosis, Complications [epainassist.com]
Ten percent of cases are bilateral and the prognosis is benign. 1 Dorsal midbrain syndrome is characterized by several signs, including eyelid retraction, nystagmus, mid-dilated pupils with light-near dissociation, and paralysis of the upward gaze. [ncbi.nlm.nih.gov]
Etiology
Adie's tonic pupil is benign neuro-ophthalmological disorder of unknown etiology. Most patients commonly present no symptoms and anisocoria is noticed accidentally. Although the etiology is unknown, there are some conditions that cause tonic pupil. [ncbi.nlm.nih.gov]
At this time, the underlying etiology of this disease is unknown. [eyewiki.org]
Epidemiology
Th e epidemiology of Sjogren’s syndrome. Clin Epidemiol 2014;6:247-55. Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Th er 2009;11:229. [scopublicaciones.socoftal.com]
Epidemiology Adie’s tonic pupil occurs in a 3:1 female to male ratio with an average age of onset of 32 years. [1] General Pathology It is thought that either a bacterial or viral infection causes inflammation which damages neurons in the ciliary ganglion [eyewiki.org]
Epidemiology Adie’s tonic pupil occurs in a 3:1 female to male ratio with an average age of onset of 32 years.[1] General Pathology It is thought that either a bacterial or viral infection causes inflammation which damages neurons in the ciliary ganglion [neuro-ophthalmology.stanford.edu]
Pathophysiology
Abstract The accepted hypothesis for the pathophysiology of tonic pupil syndrome (Adie syndrome) was reexamined in light of recent developments concerning denervation supersensitivity of cholinergically innervated smooth muscle. [ncbi.nlm.nih.gov]
What is Traumatic Iritis: Causes, Symptoms, Treatment, Pathophysiology, Prognosis, Complications [epainassist.com]
Cervical spine disease may cause either a first- or second-order Horner syndrome depending on the pathophysiology and location (eg, disk disease or intrinsic cord disease such as syrinx, tumor, or inflammation). [emedicine.medscape.com]
Bilateral tonic pupil and polyneuropathy in Sjögren's syndrome: a common pathophysiological mechanism? Eur Neurol, 1991; 31: 114–116. [link.springer.com]
Prevention
Currently, the exact cause of Adie syndrome has not been identified and it cannot be prevented Adie Syndrome presents with dilated pupil that react slowly to light, increased sensitivity to light, difficulty reading, and increased sweating. [dovemed.com]
We can hope that Holmes-Adie Syndrome can be prevented and treated better in the days ahead. [weheartvision.com]
Much of this research focuses on finding better ways to prevent, treat, and ultimately cure disorders, such as HAS. Select this link to view a list of studies currently seeking patients. [web.archive.org]
Prevention No preventative measures were noted. Resources BOOKS Bates, Barbara. A Pocket Guide to Physical Examination and History Taking. Philadelphia: Lippincott, 1991. Mareib, Elaine N. Essentials of Human Anatomy and Physiology, 3rd ed. [encyclopedia.com]