What is Adie’s Pupil?

January 28th, 2020 General Optometry | Health No Comments

Being a locum optometrist sometimes means having to expect the unexpected. Such as when a patient comes into your clinic complaining of a “weird-looking pupil”. Not your typical walk-in case so could it be the rare condition called Adie’s pupil?

Adie’s Pupil is an unusual neurological disorder that can change the shape or size of the pupil in one eye. Other symptoms include excessive or irregular sweating and the loss of deep tendon reflexes. 

Adie’s Pupil is also called Adie syndrome, Adie’s tonic pupil, Holmes-Adie syndrome or HAS for short.

How does Adie’s tonic pupil affect the eyes?

Adie’s tonic pupil affects how the pupil dilates:

  • The pupil can be abnormally large or an irregular shape, compared to the unaffected eye.
  • The pupil responds poorly to changes in light. In lower light conditions, the pupil is slower to contract than expected. The pupils struggle to contract in bright light such as contracting slowly or barely at all.
  • Typically, Adie’s only affects one eye. Although the other eye may also eventually become affected.
  • Because the pupil helps focus the light coming into the eye, Adie’s may also create blurry vision.
  • Using a loupe or microscope, the pupil will to contract slower when focusing on near objects. The sphincter muscles may respond irregularly, creating the odd-shaped pupil. 

The unusual size or shape of the pupil is not always present, however. This means that it isn’t an easy condition for an optometrist to spot. 

Plus, not everyone with Adie’s syndrome will have these symptoms of the pupil.

What are the other symptoms of Adie’s Pupil?

Adie’s tonic pupil is a neurological condition that affects the autonomic nervous system. The symptoms are not restricted to the pupils:

Poor reflexes

The reflexes, such as the knee-jerk reflex, are diminished in people with Adie’s syndrome.

Normally, the sharp tap to the patella tendon results in a sudden kicking movement of the lower leg. For people with Adie’s, the lower leg remains stationary despite the efforts of the healthcare professional administering the test.

Excessive or irregular sweating

Rare cases of Adie’s pupil also involve strange sweating patterns.

Sweating may be excessive for some individuals. Or, the body may only produce sweat from certain patches of skin.  Plus people may also experience heat intolerance due to the sweating irregularity affecting how they manage their core temperature.

Ross syndrome is a variant of Adie’s Syndrome that includes the impaired sweating ability or ‘anhidrosis’.

Photophobia

Because of how slow the pupil responds, individuals may report being overly sensitive to bright light.

Unexplained and persistent cough

There is some evidence suggesting that a persistent cough may also be associated with Adie’s syndrome.

What causes Adie’s Pupil?

The exact cause of Adie’s syndrome is generally unknown. However, most cases are likely caused by damage to the nerves around the eye such as:

  • A bacterial or viral infection that has damaged or inflamed the nerves of the ciliary ganglion in the eye socket.
  • An auto-immune condition where the body attacks the nerves supplying the eye.
  • A trauma or lack of blood supply to the eye that causes similar abnormal pupil dilation.

Similar injury to the nerves in the spine may explain the poor reflexes.

Who does Adie’s syndrome affect?

Adie’s syndrome is a rare condition affecting around 2 in 1000 people. Adie’s affects more females than males and most people are between 25-45 years of age.

What is the treatment for Adie’s pupil?

A prescription for Pilocarpine or similar eye drops can help overly dilated eyes contract.

Otherwise, the condition is managed by prescription glasses.

Does Adie Pupil go away?

Adie’s pupil is a non-progressive condition that doesn’t pose a risk to life or health in general. But there isn’t a cure and the condition won’t simply get better on it’s own. Most people learn to live with Adie’s pupil and lead perfectly normal lives.

The vision issues can be managed using eye drops and corrective eyewear. The loss of deep tendon reflexes is permanent, however.

What to do if you think a patient may have Holmes-Adie Syndrome

Patients will need a referral from their GP for a diagnosis. An ophthalmologist will perform a full eye exam plus look at the patient’s history.

But because of how Adie’s pupil can affect the vision, people with this condition will still need the help of their optometrist. Prescription glasses can help correct the blurry vision. And if the patient has light-sensitivity, prescription sunglasses may also be helpful.


My Locum Choice is here to help you on your locum journey. Whether you are thinking about locum work or you’re a seasoned pro, My Locum Choice is the friendly locum optom agency for you. We offer great advice and trusted service. So, check out the best locum shifts available through the MLC app today.


This article was written on behalf of My Locum Choice by Nicola Hasted from Pharmacy Mentor.

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