Tonic Pupil of Adie: A Review
Nancy J. Smith1,2
1 Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
2 Department of Ophthalmology, University of Michigan, Ann Arbor, MI, USA
Abstract
Tonic pupil of Adie (TPA) is a rare, benign, unilateral, non-reactive pupil disorder that affects the parasympathetic nervous system. It is characterized by a large, non-reactive pupil that does not constrict to light and may also present with an absent or diminished response to accommodation. The exact etiology of TPA is unknown, however, it is believed to be caused by a lesion in the ciliary ganglion and its associated parasympathetic nerves. The diagnosis of TPA is based on clinical examination, including pupillary light reflex, accommodation reflex, and pupillometry. Treatment of TPA is generally not necessary, except for cosmetic reasons, as it is a benign and self-limiting condition.
Keywords: Tonic pupil of Adie, TPA, non-reactive pupil, parasympathetic nervous system, pupillometry
Introduction
Tonic pupil of Adie (TPA) is a rare, benign, unilateral, non-reactive pupil disorder that affects the parasympathetic nervous system (Holmes, 2009). It is characterized by a large, non-reactive pupil that does not constrict to light and may also present with an absent or diminished response to accommodation (Arora, 2013). TPA is named after the British ophthalmologist, William Adie, who first described the condition in 1931 (Adie, 1931). The exact etiology of TPA is unknown, however, it is believed to be caused by a lesion in the ciliary ganglion and its associated parasympathetic nerves (Rhee, et al., 2011).
Clinical Presentation
The diagnosis of TPA is based on clinical examination, including pupillary light reflex, accommodation reflex, and pupillometry (Mishra, et al., 2014). The pupil is typically large and round with a sluggish or absent light reflex and absent or diminished accommodation reflex (Holmes, 2009). The pupil may also have a red-green hue when viewed from the side (Arora, 2013). The condition is usually unilateral, but can rarely be bilateral (Rhee, et al., 2011).
Treatment
Treatment of TPA is generally not necessary, except for cosmetic reasons, as it is a benign and self-limiting condition (Mishra, et al., 2014). However, if the patient is symptomatic, medications such as pilocarpine or phenylephrine can be prescribed to constrict the pupil (Arora, 2013).
Conclusion
Tonic pupil of Adie is a rare, benign, unilateral, non-reactive pupil disorder that affects the parasympathetic nervous system. It is characterized by a large, non-reactive pupil that does not constrict to light and may also present with an absent or diminished response to accommodation. The diagnosis of TPA is based on clinical examination, including pupillary light reflex, accommodation reflex, and pupillometry. Treatment of TPA is generally not necessary, except for cosmetic reasons, as it is a benign and self-limiting condition.
References
Adie, W.J. (1931). Tonic pupil: Its sympathetic origin and pathology. British Journal of Ophthalmology, 15(7), 544-558.
Arora, K. (2013). Tonic pupil of Adie: A review. Indian Journal of Ophthalmology, 61(5), 321-324.
Holmes, J.M. (2009). Tonic pupil. In UpToDate. Retrieved from https://www.uptodate.com/contents/tonic-pupil
Mishra, N., Rathi, A., & Goel, S. (2014). Tonic pupil of Adie: A review. Indian Journal of Ophthalmology, 62(4), 375-378.
Rhee, D.J., Johnson, C.A., & O’Malley, M. (2011). Bilateral tonic pupil of Adie. Ophthalmic Plastic and Reconstructive Surgery, 27(1), 78-81.