Adie’s Pupil: A Diagnostic Challenge for the Physician

Abstract

Adie’s pupil, also called tonic pupil, is mainly seen in young women. Most patients have unilateral eye involvement. The pupil of the affected side is significantly larger than that on the healthy side. The direct and indirect light reflection from the pupil on the affected side disappears. The pupil on the affected side is sensitive to low concentrations of pilocarpine. The pathogeneses of Adie’s pupil are complex, some of which are insidious and lack corresponding specific diseases. Through a literature review, we found that Adie’s pupil is mainly associated with infectious diseases, most commonly syphilis, followed by immune diseases and paraneoplastic syndromes. The ophthalmological symptoms and pupil abnormalities can disappear after active treatment of the primary disease. Pilocarpine can be used to treat ophthalmologic symptoms, such as blurred vision, for which patients might visit an ophthalmologist or neurologist. It is essential for clinicians to improve their understanding of the disease to avoid misdiagnosis. Differential diagnosis between Adie’s pupil, oculomotor nerve palsy, anticholinergic drug overdose, Argyll-Robertson pupil, and congenital mydriasis need to be identified by the physician. Here, the clinical manifestations, pathogenesis, relationship between Adie’s pupil and diseases, and differential diagnosis of Adie’s pupil are reviewed.

Adie pupil. Literature review

“…Nu sta ty ta, kad to ni ná vyz dá ga li su kel ti ávai rûs in fek ciniai su sir gi mai -si fi lis, ágy tas imu no de fi ci to sin dro mas (AIDS), vë ja rau piai, juos ti në pûs le li në, Lai mo li ga, papras to ji pûs le li në, par vo vi ru si në B19 in fek ci ja, he pa ti tai ir COVID-19 in fek ci ja [14][15][16][17][18].…”

“…To ni nis vyz dys taip pat sie ja mas su pa ra ne op las ti niais sin dro mais (Hodþ ki no lim fo ma, krû tø vë þiu, tar pup lau èio smul kiø jø làs te liø kar ci no ma, ade noi di ne cis ti ne kar ci noma), anes te zi ja, vais tø var to ji mu ir ki to mis bûk lë mis [7,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Bilateral tonic pupil during a migraine attack: a case report.

“…It is often unilateral but bilateral involvement is observed in up to 20% of patients. It occurs predominantly in young women (1). It is caused by eye pathologies, such as infections, including syphilis (2), trauma, neoplasms, inflammatory diseases (3) and may be associated with systemic diseases with autonomic dysfunction.…”