This new case, the 6-year follow-up from the previous case, and a discussion of tonic pupils are presented. [ncbi.nlm.nih.gov]

• Weakness

  We report two patients with long-standing lepromatous leprosy who developed tonic pupils characterized by mydriasis, absence of reaction to light and hypersensitivity to weak cholinergic solution. Examination revealed iritis and iris atrophy. [ncbi.nlm.nih.gov]

  Evidence supporting the role of sympathetic postganglionic denervation has been pharmacologically demonstrated by the hypersensitivity response following the instillation of very weak concentrations of epinephrine ( 4 ). [scielo.br]

  (B) Bilateral Constricted Pupils Due to Supersensitivity to the Weak Pilocarpine Drops. [healio.com]

  A 57-year-old woman with numbness and weakness of the feet and legs. N Engl J Med. 2006;354:2584-2592. http://www.ncbi.nlm.nih.gov/pubmed/16775239 Martinelli P, Minardi C. Tonic pupil and tendon areflexia: the Holmes-Adie’s syndrome. [rarediseases.org]

• Camping

  Energy Kardio Club - Preturi Acasa Preturi GROUP TRAINING ABONAMENTE PRET ÎNTREG PANA LA ORA 12.00 ELEVI/ PENSIONARI 3 LUNI 6 LUNI 12 LUNI bodyART, deepwork, TRX, KARDIO KICK BOXING, TAE-BO, STEEL TONIC, KARDIO STEP, BOOT CAMP, MILITARY WORKOUT, BODY [energykardioclub.ro]

• Falling

  Paroxysmal coughing during head up tilt resulted in a fall in blood pressure from 151/99 to 98/70 mm Hg, inducing presyncope. He was treated with a high salt intake and fludrocortisone to improve orthostatic tolerance. [jnnp.bmj.com]

• Hypotension

  Those symptoms (emotional instability, loss of sweating, orthostatic hypotensive symptoms, and signs of bilaterality of the tonic pupil) which should alert the clinician to more extensive disease states are noted. [ncbi.nlm.nih.gov]

  Holmes-Adie syndrome includes other features, notably diminished deep tendon reflexes and orthostatic hypotension. In the initial stages, a tonic pupil is dilated and poorly reactive. [aao.org]

  He then developed symptoms of postural hypotension and was bothered by frequent paroxysms of coughing that resulted in syncope on several occasions. There was no history of lung disease. [jnnp.bmj.com]

  When Deep Tendon Reflexes (DTRs) of the legs—knee and ankle jerks—are also affected, accompanied by symptoms including localized, discreet areas of the skin that do not sweat, postural hypotension (low blood pressure related to sudden standing or rising [healthboards.com]

• 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 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 [sboportal.org.br]

  One suggested method for distinguishing between these two possible causes is examination for anisocoria and sector palsy. [eyewiki.com]

  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

  Case Report A 36-year-old woman visited a neurology department with a 7-day history of throbbing headache and blurred vision in both eyes. [ncbi.nlm.nih.gov]

  Symptoms can include blurred vision, loss of color vision, floaters, light sensitivity, metamorphopsia and vision loss. wraparound Also called "wrap" for short. [allaboutvision.com]

• Pupillary Abnormality

  This pupillary abnormality may result from ischaemia of the ciliary ganglia. [ncbi.nlm.nih.gov]

  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]

  […] 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]

  Rechercher un concept terminologique arbre Semiology Neurologic Manifestations Pupil Disorders Pupillotony Adie Syndrome Visualisez ce concept sur le site Concept TE.66031 définition A pupillary abnormality characterized by a poor pupillary light reaction [termsciences.fr]

• Diplopia

  Pupil of other eye may later become similarly affected Refer patient emergently to ophthalmologist or emergency room if you find upper lid ptosis and miosis, especially if acute and accompanied by new neck pain or diplopia [kellogg.umich.edu]

  If diplopia persists when one eye is closed (monocular diplopia), the cause is probably a nonneurologic eye disorder. If diplopia disappears when either eye is closed (binocular diplopia), the cause is probably a disorder of ocular motility. [merckmanuals.com]

  There was no diplopia or nystagmus. Her ocular movements, including the saccadic and smooth pursuit eye movements, were normal. There was no eyeball deviation or lid retraction. Both pupils were dilated (6 mm) and unresponsive to light. [ncbi.nlm.nih.gov]

• Visual Impairment

  The eyelashes begin to scrape the eyeball and cornea, which eventually causes visual impairment and blindness. Worldwide, 84 million people are affected by trachoma. [allaboutvision.com]

• 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]

  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]

  Headache is not a common part of the syndrome, but could be due to problems with your vision. Wearing sunglasses, or even patching the affected eye, may reduce the strain, and perhaps relieve the headache. [eyecaretrust.org.uk]

• Stroke

  […] represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. [web.archive.org]

  Curr Opin Neurol. (2008) 1, 36-42 ↑ National Institute of Neurological Disorders and Stroke, NINDS Holmes-Adie Syndrome Information Page, www.ninds.gov/disorders/holmes_adie (2011) [eyewiki.com]

  He has only see 3 cases of a person with a blown pupil - one from a stroke, one from a ceberal 3rd nerve palsy, and one from Adie's. So he decided to do the pilocarpine drop test. [healthboards.com]

  Cassim Late contralateral hyperhidrosis in lateral medullary infarcts Stroke, 27 (1996), pp. 991-995 [12.] R.J. Landreneau, H.J. Mack, S.R. Hazelrigg, R.D. Dowling, T.E. Acuff, M.J. [archbronconeumol.org]

• Vertigo

  She reported associated vertigo. She searched for neurological aid and a MRI of the brain was performed without changes. [scielo.br]

  sense of fullness in the ear, and hearing loss Meniere disease Barotrauma Benign paroxysmal positional vertigo Otolithic aggregation in the posterior or horizontal semicircular canal, related to aging and/or trauma Infection (occasionally) Vestibular [merckmanuals.com]

  […] patches (“cruise ship” anisocoria) – neosynephrine nasal sprays or eyedrops – flea collar powders (anti-cholinesterases) – inquire about abnormal neurological symtoms – focal weakness or sensory deficits – dysarthria or dysphagia or diploplia – ataxia or vertigo [lifeinthefastlane.com]

• Meningism

  Human herpesvirus 6 (HHV-6), a widespread virus and causative agent of exanthema subitum in children, has been associated with a number of neurologic disorders including cranial nerve palsies, seizures, encephalitis, meningitis, and multiple sclerosis [ncbi.nlm.nih.gov]

  Hypoglossal (12th) Moves the tongue Atrophy and fasciculation of tongue Intramedullary lesions (eg, motor neuron disease, tumors) Lesions of the basal meninges or occipital bones (eg, platybasia, Paget disease of skull base) Surgical trauma (eg, due [merckmanuals.com]

  Causes: congenital cataract,  retinoblastoma,  ROP,  toxocaris 13. 7-Hutchinson’s pupil due to the compression of the 3rd nerve which is due to the meningeal hemorrhage at the base of the brain. [slideshare.net]

  Multiple cranial nerve palsies: this suggests intracranial or meningeal tumour, polyneuropathy or cavernous sinus lesion. Horner's syndrome This is a relatively rare disorder caused by an interruption of the sympathetic nerve supply to the eye. [patient.info]

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]

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]

The usual treatment of a standardised Adie syndrome is to prescribe reading glasses to correct for impairment of the eye(s).[1] Pilocarpine drops may be administered as a treatment as well as a diagnostic measure, and should be applied three times daily [eyecare-information-service.org.uk]

What is Traumatic Iritis: Causes, Symptoms, Treatment, Pathophysiology, Prognosis, Complications [epainassist.com]

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]

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]

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]

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]

Any history or findings indicating a more general neuropathy, such as history of Diabetic Autonomic Neuropathy, could suggest an etiology of the mydriasis other than Adie’s Tonic Pupil. [eyewiki.com]

At this time, the underlying etiology of this disease is unknown. [eyewiki.org]

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]

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]

Bilateral tonic pupil and polyneuropathy in Sjögren's syndrome: a common pathophysiological mechanism? Eur Neurol, 1991; 31: 114–116. [link.springer.com]

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]

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]

We can hope that Holmes-Adie Syndrome can be prevented and treated better in the days ahead. [weheartvision.com]

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]