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Anisocoria: Big Pupil

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  • First Online:
Encyclopedia of Ophthalmology

  • 52 Accesses

Synonyms

Adie syndrome; Adie’s tonic pupil; Holmes-Adie syndrome; Little old Adie’s pupil

Definition

The Adie tonic pupil (ATP) is characterized acutely by a dilated ipsilateral pupil with an impaired light reaction. Over time the pupil becomes smaller (i.e., “little old Adie”) and develops a tonic near reaction (light-near dissociation). ATP is caused by damage to the parasympathetic innervation to the eye at the level of the ciliary ganglion or postganglionic fibers.

Etiology

ATP is caused by damage to the parasympathetic innervation to the iris and ciliary body at the ciliary ganglion or postganglionic nerves. Initially, the pupil reacts poorly to both light and accommodation and thus can mimic a pharmacologically dilated pupil. Over the next few days to weeks after the acute denervation, however, postganglionic axons can regenerate, but some regeneration may occur aberrantly. Normally, there are up to 30 times more parasympathetic axons arising from the ciliary ganglion and...

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Further Reading

  • Jacobson DM (1990) Pupillary responses to dilute pilocarpine in preganglionic 3rd nerve disorders. Neurology 40(5):804

    Article  CAS  PubMed  Google Scholar 

  • Jacobson DM (1994) A prospective evaluation of cholinergic supersensitivity of the iris sphincter in patients with oculomotor nerve palsies. Am J Ophthalmol 118(3):377

    Article  CAS  PubMed  Google Scholar 

  • Leavitt JA, Wayman LL, Hodge DO, Brubaker RF (2002) Pupillary response to four concentrations of pilocarpine in normal subjects: application to testing for Adie tonic pupil. Am J Ophthalmol 133:333

    Article  CAS  PubMed  Google Scholar 

  • Sakai T, Shikishima K, Mizobuchi T, Yoshida M, Kitahara K (2003) Bilateral tonic pupils associated with neurosyphilis. Jpn J Ophthalmol 47(4):368

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  • Thompson HS (1977) Adie’s syndrome: some new observations. Trans Am Ophthalmol Soc 75:587

    CAS  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA

    Effie Z. Rahman, Angelina Espino Barros Palau & Andrew G. Lee

  2. Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, TX, USA

    Andrew G. Lee

  3. Department of Ophthalmology, The University of Texas Medical Branch, Galveston, TX, USA

    Andrew G. Lee

  4. UT MD Anderson Cancer Center, Houston, TX, USA

    Andrew G. Lee

  5. Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street, Scurlock 450, Houston, TX, 77030, USA

    Andrew G. Lee

  6. Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Andrew G. Lee

Authors
  1. Effie Z. Rahman
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  2. Angelina Espino Barros Palau
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  3. Andrew G. Lee
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Corresponding author

Correspondence to Andrew G. Lee .

Editor information

Editors and Affiliations

  1. Dept of Ophthal & Optometry,AKH, Medical University of Wien Dept of Ophthal & Optometry,AKH, Wien, Austria

    Ursula Schmidt-Erfurth

  2. Department of Ophthalmology, Goethe University of Frankfurt am Main Department of Ophthalmology, Frankfurt am Main, Germany

    Thomas Kohnen

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© 2015 Springer Science Business Media, New York (outside the USA)

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Rahman, E.Z., Espino Barros Palau, A., Lee, A.G. (2015). Anisocoria: Big Pupil. In: Schmidt-Erfurth, U., Kohnen, T. (eds) Encyclopedia of Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35951-4_526-1

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  • DOI: https://doi.org/10.1007/978-3-642-35951-4_526-1

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Online ISBN: 978-3-642-35951-4

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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