Partial iridoplegia with symptoms of other diseases of the nervous system. Internal Ophthalmoplegia with Absent Tendon-jerks. Pseudo-Argyll Robertson Pupils With Absent Tendon Reflexes: A Benign Disorder Simulating Tabes Dorsalis. Pupillary Response to four concentrations of pilocarpine in normal subjects: application to testing for Adie tonic pupil. Leavitt JA, Wayman LL, Hodge DO, Brubaker RF.Slit-lamp Smartphone photography REFERENCES On fast up-gaze, the eyes pull in and the globes retract. Convergence-retraction nystagmus: Attempts at upward gaze often produce this phenomenon. Smartphone slit-lamp photography is the new advancement in the field of science and technology in which photographs of the desired slit-lamp finding can be taken with smartphones by using the slit-lamp adapters. Pseudo- Argyll Robertson pupils: Accommodative paresis ensues, and pupils become mid-dilated and show light-near dissociation. HOW TO TAKE SLIT-LAMP EXAM IMAGES WITH A SMARTPHONE? If an underlying systemic cause for the tonic pupil is suspected, patients should have treatment directed toward their systemic neuropathies. In patients with persistent accommodative paresis, frosted bifocal segments may be used to correct vision. It must be noted that these medications can precipitate ciliary spasms, and brow aches, worsen anisocoria, or induce nearsightedness. When Douglas Argyll Robertson first described the pupils that bear his name. While in general treatment is not required for Adie tonic pupil, dilute topical pilocarpine or physostigmine can be used for symptomatic relief in cases with severe photophobia. 11 Bulbar and pseudobulbar palsy 12 Catatonic-like states 13 Chorea 14 Coma. However, patients may experience increased light-near dissociation over time since the pupil’s reaction to light does not typically recover. Pseudo- Argyll Robertson Pupil with absent tendon reflexes-A benign disorder. Accommodative paresis may resolve with time, ranging from months to years. Argyll Robertson Pupil: This lesion is a hallmark of tertiary neurosyphilis. However, patients may experience photophobia and blurry vision. Xu SY, Song MM, Li L, Li CX Med Sci Monit 2022 Mar 8 28:e934657. Patients may also present with decreased deep tendon reflexes in the full Holmes-Adie Syndrome.Īdie tonic pupil is a benign condition and generally patients only require reassurance. Adie's Pupil: A Diagnostic Challenge for the Physician. The affected pupil, either unilateral or bilateral typically initially appears abnormally dilated at rest and has a poor or sluggish pupillary constriction in bright light.Ĭonstriction is typically more notable with the near reaction and typically remains tonically constricted with slow re-dilation with segmental paralysis of the iris sphincter. ![]() DISEASEĪdie tonic pupil, known as Adie’s Syndrome or Holmes-Adie Syndrome, is a disorder in which there is parasympathetic denervation of the afflicted pupil resulting in poor light but better and tonic near constriction. ![]() Neurological examination was otherwise normal, and a diagnosis of Adie’s tonic pupil was made. This also resulted in the resolution of his photophobia and blurry vision. Pharmacological testing with dilute pilocarpine 0.1% resulted in constriction of the right pupil but no change in the left pupil.
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