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| adie_tonic_pupil [2026/06/22 00:11] – created Scott Larson | adie_tonic_pupil [2026/06/22 00:39] (current) – [Characteristics] Scott Larson | ||
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| ====== Adie tonic pupil ====== | ====== Adie tonic pupil ====== | ||
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| + | ====Characteristics==== | ||
| + | * Anisocoria worse in bright light (poor iris sphincter constriction) | ||
| + | * Most often affects young to middle-aged women (average onset 32 years, prevalence estimated at 0.02%) | ||
| + | * Unilateral in 80% | ||
| + | * Light-near dissociation | ||
| + | * dysinnervation of the iris sphincter parasympathetic innervation is present but recovery of the accommodative iris sphincter input occurs | ||
| + | * slow tonic constriction to near fixation (light/near dissociation) and slow redilation | ||
| + | * Segmental iris sphincter paresis produces vermiform movements | ||
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| + | ====Causes=== | ||
| + | * Idiopathic | ||
| + | * Infectious | ||
| + | * HSV, VZV, Syphilis | ||
| + | * Autoimmune/ | ||
| + | * Lupus | ||
| + | * Sjögren syndrome | ||
| + | * Guillian-Barré syndrome | ||
| + | * Miller-Fisher syndrome | ||
| + | * Autonomic neuropathy | ||
| + | * Acute Pandysautonomia | ||
| + | * Shy-Drager syndrome | ||
| + | * Ross syndrome ( tonic pupil + hyporeflexia +segmental anhidrosis) | ||
| + | * Metabolic/ | ||
| + | * Diabetes | ||
| + | * Chronic alcoholism | ||
| + | * toxic neuropathies | ||
| + | * botulism | ||
| + | * Paraneoplastic | ||
| + | * Small-cell lung carcinoma (ANNA-1/ | ||
| + | * Hodgkin lymphoma | ||
| + | * testicular seminoma | ||
| + | * Ocular trauma | ||
| + | * Hereditary | ||
| + | * Spinocerebellar ataxia | ||
| + | * hereditary neuropathy | ||
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| + | ====Testing==== | ||
| + | * Dilute pilocarpine test | ||
| + | * Pilocarpine 0.0625%-0.125% | ||
| + | * One study of 0.0625% pilocarpine showed 100% sensitivity and 82.8% specificity. | ||
| + | * Because this response is due to supersensitvity, | ||
| + | * False positive results in pre ganglionic CN III lesions. | ||
| + | * Dilute Pilocarpine 1% in solution with sterile saline | ||
| + | * 1 part pilocarpine 1% and 9 parts saline gives 0.1%) | ||
| + | |||
| + | ====Prognosis==== | ||
| + | * 25% get progressive smaller pupil with parasympathetic reinnervation | ||
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| + | ====References==== | ||
| + | - [[https:// | ||
| + | - [[https:// | ||
| + | - [[https:// | ||
| + | - [[https:// | ||
| + | - [[https:// | ||