Adie syndrome

A neurological disorder affecting the pupil and autonomic nervous system

Adie syndrome, also known as Adie's tonic pupil, is a neurological disorder characterized by a pupil that is larger than normal and reacts slowly to light. It is often associated with absent or diminished deep tendon reflexes, particularly in the Achilles tendon. The condition is named after the British neurologist William John Adie.

Signs and symptoms

The primary feature of Adie syndrome is a tonic pupil, which is a pupil that is larger than normal and reacts slowly to light. This can cause difficulty with focusing, particularly when shifting gaze from near to far objects. Patients may also experience photophobia, or sensitivity to light.

In addition to the tonic pupil, individuals with Adie syndrome often have absent or diminished deep tendon reflexes, most commonly in the Achilles tendon. This is due to the involvement of the autonomic nervous system.

Causes

The exact cause of Adie syndrome is not well understood, but it is believed to result from damage to the postganglionic fibers of the parasympathetic nervous system that innervate the eye. This damage may be due to a viral or bacterial infection, trauma, or other unknown factors.

Diagnosis

Diagnosis of Adie syndrome is primarily clinical, based on the characteristic signs and symptoms. A thorough eye examination will reveal the tonic pupil, and neurological examination may show absent or diminished deep tendon reflexes. Additional tests, such as pharmacologic testing with dilute pilocarpine, can help confirm the diagnosis by demonstrating supersensitivity of the affected pupil.

Treatment

There is no cure for Adie syndrome, but treatment focuses on managing symptoms. Reading glasses or bifocals can help with focusing difficulties. Sunglasses may be recommended to reduce photophobia. In some cases, pilocarpine eye drops may be used to constrict the pupil and improve near vision.

Prognosis

Adie syndrome is a benign condition, and while symptoms may persist, they do not typically worsen over time. Some patients may experience improvement in symptoms, particularly the deep tendon reflexes, over several years.

Related pages

• Pupil
• Autonomic nervous system
• Neurology
• William John Adie

Gallery

• 
  An example of a tonic pupil in Adie syndrome