Adie syndrome

Adie syndrome, also Adie's syndrome, Adie's Tonic Pupil or Holmes-Adie's syndrome, is caused by damage to the postganglionic fibers of the parasympathetic innervation of the eye and characterized by a tonically dilated pupil. It most commonly affects younger women and is unilateral in 80% of cases. The pupil is characteristically poorly reactive to light but slowly reactive to accommodation. This clinical picture is often accompanied by signs of aberrant regeneration of these nerves and asymmetrically reduced deep tendon reflexes.

Signs and symptoms may/can include blurry vision due to accommodative paresis, photophobia and difficulty reading.

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".

Testing with low dose (1/8%) pilocarpine may constrict the tonic pupil due to cholinergic denervation supersensitivity. A normal pupil will not constrict with the dilute dose of pilocarpine.

No specific treatment is required unless glare is overly symptomatic.

Eponym
It is named for William John Adie.

Additional Resources

 * "Adie syndrome." Stedman's Medical Dictionary, 27th ed. (2000). ISBN 0-683-40007-X
 * Haines, Duane E. Fundamental Neuroscience, 2nd ed. (2002). ISBN 0-443-06603-5