J Korean Ophthalmol Soc.  2013 May;54(5):777-783. 10.3341/jkos.2013.54.5.777.

Clinical Features of Adie's Tonic Pupil: A Retrospective and Cross-Sectional Study

• Lee HJ
• Lee JY
• Um TW
• Lim HT
• Ahn HS

• KMID: 2217045
• DOI: http://doi.org/10.3341/jkos.2013.54.5.777

Abstract

PURPOSE
To report the clinical features of Adie's tonic pupil.
METHODS
The medical records of 22 patients who had been diagnosed with Adie's tonic pupil from February 1998 to February 2009, were retrospectively reviewed. On March 2010, a cross-sectional examination was performed in 16 patients (19 eyes) who underwent a follow-up of more than 1 year. Measurements included pupil size in room light, bright light and in darkness; near point of accommodation; presence of segmental iris palsy; light-near dissociation; denervation supersensitivity; corneal sensitivity; and deep tendon reflex (DTR).
RESULTS
Among the patients studied, 16 were women in Adie's tonic pupils. Only 3 of patients had bilateral involvement. The mean age of onset was 38.3 years. The mean size of Adie's tonic pupils was 2.3 mm larger than the fellow eyes. Segmental iris palsy was detected in 93.8% of the patients. Denervation supersensitivity was observed in all patients. Light-near dissociation was present in 88.2% and over 90% of the patients had decreased DTR in the biceps, triceps, knee and ankle jerk.
CONCLUSIONS
This cross-sectional study showed Adie's tonic pupil tended to become miotic and recover accommodation power over the years.

Keyword

Adie's tonic pupil; Deep tendon reflex; Denervation supersensitivity; Light-near dissociation; Segmental iris palsy

MeSH Terms

Age of Onset
Animals
Ankle
Cross-Sectional Studies
Denervation
Dissociative Disorders
Eye
Female
Follow-Up Studies
Humans
Iris
Knee
Light
Medical Records
Paralysis
Pupil
Reflex, Stretch
Retrospective Studies
Tonic Pupil

Figure

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  Figure 1. Differences of pupil size between Adie’s tonic pupils and fellow eyes under variable conditions.

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  Figure 2. Comparison of light-near dissociation between Adie’s tonic pupils and fellow eyes.

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  Figure 3. Patients number of iris segmental palsies for each clock hour of the affected sphincter.

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  Figure 4. Number of patients according to the regions of de-creased corneal sensation.

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  Figure 5. Denervation supersensitivity test: The serial changes of Adie’s tonic pupils at the baseline, 10, 20 and 30 minutes af-ter 0.125% pilocarpine instillation.

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  Figure 6. Comparison of deep tendon reflex between Adie’s tonic pupil patients and control group.

Reference

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