Segmental palsy of the sphincter muscles (arrows). Best
seen on slit-lamp.
. Note: The arrow represents the light.
Right dilated pupil
Right pupil has no light reflex.
Pupils react to accommodation
The patient (usually a female) has anisocoria with the enlarged pupil failing to react to light. However, the pupil constricts in response to accommodation with delayed dilatation (this results in reversal of anisocoria).
Note: Adie's pupil is bilateral in 15% of cases and in long-standing cases the pupil may be miosed.
- mention you would like to examine the iris on the slit-lamp for segmental palsies and vermiform movement of the iris
- mention that you would like to test the tendon reflexes. This is absent in 70% of patient (Holme-Adie's syndrome)
1. How can one confirm Adie's pupil?