Adie syndrome

Adie syndrome, sometimes known as Holmes-Adie's syndrome or Adie's Tonic Pupil, is a neurological disorder which affects the pupil of the eye and the autonomic nervous system.^[1] It is named after the British neurologist William John Adie. It is caused by damage to the postganglionic fibers of the parasympathetic innervation of the eye, usually by a viral or bacterial infection which causes inflammation, and characterized by a tonically dilated pupil.^[1]

Signs and Symptoms

This photograph shows an abnormally sized pupil which has been dilated with eye drops

Adie syndrome presents with three hallmark symptoms, namely at least one abnormally dilated pupil (mydriasis), loss of deep tendon reflexes and diaphoresis (excessive sweating).^[1] Other signs may include hyperopia due to accommodative paresis, photophobia and difficulty reading.^[2]

Causes

Associated with Retinal Detachment surgery, especially when a scleral buckle is used.^[3]

Diagnosis

Clinical exam may reveal sectoral paresis of the iris sphincter and/or vermiform iris movements. The tonic pupil may become smaller (miotic) over time which is referred to as "little old Adie's".^[4] Testing with low dose (1/8%) pilocarpine may constrict the tonic pupil due to cholinergic denervation supersensitivity.^[1] A normal pupil will not constrict with the dilute dose of pilocarpine.^[4] CT scans and MRI scans may be useful in the diagnostic testing of focal hypoactive reflexes.^[5]

Treatment

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.^[1] Thoracic sympathectomy is the definitive treatment of diaphoresis, if the condition is not treatable by drug therapy.^[1]

Prognosis

Adie's syndrome is not life threatening or disabling.^[1] As such, there is no mortality rate relating to the condition, however loss of deep tendon reflexes is permanent and may progress over time.^[1]

Epidemiology

It most commonly affects younger women and is unilateral in 80% of cases.^[4]

See also

• Ross’ syndrome

References

1. ^ ^{a b c d e f g h i} "Holmes-Adie syndrome Information Page". National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/holmes_adie/holmes_adie.htm. Retrieved 2008-01-21. 
2. ^ Stedman's Medical Dictionary, 27th Edition. 2000. ISBN 0-683-40007-X. 
3. ^ http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2728613
4. ^ ^{a b c} Haines, Duane E. (2002). Fundamental Neuroscience, 2nd edition. ISBN 0-443-06603-5. 
5. ^ "Diagnosis of Adie syndrome". WrongDiagnosis.com. http://www.wrongdiagnosis.com/a/adie_syndrome/diagnosis.htm. Retrieved 2008-01-21. 

External links

• Personal experience
• Animation at mrcophth.com

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