Adie syndrome

A neurological disorder affecting the pupil of the eye

Adie syndrome, also known as Adie's tonic pupil, is a neurological disorder characterized by a pupil that is larger than normal and reacts slowly to light. It is often associated with absent or diminished deep tendon reflexes. The condition is named after the British neurologist William John Adie.

Signs and symptoms

Illustration of Adie syndrome showing a dilated pupil

The primary symptom of Adie syndrome is a tonic pupil, which is a pupil that is abnormally dilated and responds slowly to light. This can lead to difficulties with focusing, especially when transitioning from bright to dim lighting. Patients may also experience blurred vision and sensitivity to light.

In addition to the ocular symptoms, individuals with Adie syndrome often exhibit diminished or absent deep tendon reflexes, particularly in the Achilles tendon. This combination of symptoms is sometimes referred to as Holmes-Adie syndrome.

Causes

The exact cause of Adie syndrome is not well understood, but it is believed to result from damage to the postganglionic fibers of the parasympathetic nervous system that innervate the eye. This damage may be due to a viral or bacterial infection, trauma, or other unknown factors.

Diagnosis

Diagnosis of Adie syndrome is primarily clinical, based on the characteristic presentation of a tonic pupil and absent reflexes. A thorough eye examination is conducted, and pharmacological testing with dilute pilocarpine may be used to confirm the diagnosis. In Adie syndrome, the affected pupil will constrict more than the normal pupil when exposed to dilute pilocarpine.

Treatment

There is no cure for Adie syndrome, but treatment focuses on managing symptoms. Reading glasses may be prescribed to help with focusing difficulties. In some cases, pilocarpine eye drops are used to constrict the pupil and improve vision. Patients are also advised to protect their eyes from bright light.

Prognosis

Adie syndrome is a benign condition, and while the symptoms can be bothersome, they do not typically lead to serious complications. Over time, the affected pupil may become smaller and less reactive, and reflexes may partially return.

Related pages

• Pupil
• Parasympathetic nervous system
• Neurology
• Reflex