Adie's tonic pupil presenting with unilateral photophobia successfully treated with dilute pilocarpine.

A 40-year-old healthy man presented with a 4-month history of photophobia, blurred vision and a right dilated pupil. Examination revealed a right pupil that was not reactive to light but constricted strongly to a near target and slowly redilated when he looked back in the distance. Pharmacological testing with dilute pilocarpine 0.1% resulted in constriction of the right pupil but no change in the left pupil. This also resulted in resolution of his photophobia and blurry vision. Neurological examination was otherwise normal, and a diagnosis of Adie's tonic pupil was made. The main differential diagnosis to consider for a large pupil is a third nerve palsy, pharmacological mydriasis, tonic pupil and local iris processes, such as iris sphincter tears from trauma. Knowledge of the key features of these conditions can avoid wasted resources from unnecessary testing. Dilute pilocarpine 0.1% three times a day can be considered as a pharmacological therapy for symptomatic relief.

A rare presentation of neurosyphilis mimicking a unilateral Adie's tonic pupil.

We describe a case of a female patient who presented with anisocoria and was initially diagnosed with a right acute Adie's pupil on the basis of a right tonic pupil with absent oculomotor or neurological findings and hyper-responsiveness to dilute Pilocarpine. Two months later, the patient returned with bilateral tonic pupils and limitation of extraocular movement in the right eye. Subsequent laboratory testing revealed neurosyphilis. Our case, only the second ever reported, emphasizes the importance of considering the diagnosis of neurosyphilis in patients presenting with an isolated acute tonic pupil.

Bilateral Holmes-Adie syndrome as an early manifestation of the HIV neuropathy.

A 38-year-old HIV-1 infected woman affected with bilateral tonic pupils. Ophthalmologic examination confirmed Holmes-Adie syndrome (HAS), and peripheral distal polyneuropathy, orthostatic hypotension and leg hyperhidrosis were detected on further workup. The HAS can be either idiopathic or associated with neuropathy of various etiology (autoimmune, paraneoplastic and infectious). In our patient, the pupillotonia was the first and early symptom of hitherto unrecognized HIV neuropathy. HAS has been previously observed in association with syphilis, Lyme borreliosis, herpes simplex and parvovirus B19 infection. Our case is the first report of HAS in a case of HIV infection.

Adie syndrome as the initial sign of primary Sjögren syndrome.

PURPOSE: To report Adie syndrome as the initial sign of primary Sjögren syndrome. METHODS: Case report. RESULTS: Adie syndrome was associated with necrotizing gingivitis and xerostomia. Antibodies against Ro (SS-A) were present. Prednisone and antimalarial drugs were ineffective in treating Adie syndrome but improved the necrotizing gingivitis. CONCLUSION: Search for Sjögren syndrome is mandated in patients with Adie syndrome. The latter condition is likely related to ganglionitis, a mechanism responsible for peripheral nervous system involvement in primary Sjögren syndrome.

Síndrome de ADIE / ADIE syndrome

A Síndrome de Adie, caracterizada por pupila tônica, hipossensibilidade corneana e hipo ou arreflexia dos tendöes profundos, é uma patologia neuroftalmológica benigna, porém evolutiva, cujo conhecimento apresentava, além do interese do ponto de vista acadêmico, aspectos práticos muito úteis, evitando exames dispendiosos e invasivos. Os autores revisam o assunto e apresentam um estudo de 12 pacientes com a Síndrome, salientando suas características, fisiopatologia e diagnóstico

The therapy of Adie's syndrome with dilute pilocarpine hydrochloride solutions.

Impressed by the benefit two patients with Adie's Syndrome derived from topical 0.1% pilocarpine therapy, we performed the present study to examine the measurable effects of 0.1% pilocarpine in several patients with this syndrome. Our study suggests those patients with Adie's Syndrome who lack stereoacuity may benefit from long term therapy with dilute pilocarpine if their stereoacuity may benefit from long term therapy with dilute pilocarpine if their stereoacuity improves following a single drop of 0.1% pilocarpine. Therefore, we recommend measuring stereoacuity during pupil diagnostic testing with 0.1% pilocarpine hydrochloride. Potential problems concerning medical therapy of Adie's Syndrome with parasympathomimetics are discussed.

Adie's syndrome: a medical treatment for symptomatic patients.

A symptomatic patient with Adie's syndrome is described as successfully managed with pilocarpine 0.125% applied topically to the involved eye three times daily. This is the first report of such a patient responding to direct parasympathomimetic therapy. Alternate approaches to the therapy of Adie's syndrome are mentioned. An approach to the management of Adie's syndrome is proposed.

[Observations in two cases of Adie's syndrome (author's transl)]. / Das Adie-Syndrom. Betrachtungen über zwei Fälle.

In this paper two cases of Adie's syndrome are discussed. In one of them a paralysis of accommodation was observed. In neither case was it possible to establish the etiology. In both cases the pupil was still enlarged, 11 and seven months later, respectively.