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Miotic Adie's pupils.

M L Rosenberg¹

¹Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799.

Journal of Clinical Neuro-Ophthalmology

|March 1, 1989

Summary

This study suggests some patients may have primary miotic Adie's pupils, presenting as small, poorly reactive pupils, without the typical dilated pupil phase. This challenges the traditional understanding of Adie's syndrome progression.

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Area of Science:

Ophthalmology
Neurology

Background:

Adie's syndrome typically presents with a unilaterally dilated pupil (mydriasis) that constricts poorly to light but briskly to near accommodation.
A key diagnostic feature is supersensitivity to dilute pilocarpine eye drops.

Observation:

Two young adults (24 and 31 years old) presented with a long-standing history of bilateral miosis (small pupils).
Review of old photographs confirmed miosis for 10 and 5 years, respectively.
Both individuals exhibited bilateral tonic pupils that were supersensitive to pilocarpine.

Findings:

The observed bilateral miosis and tonic pupil characteristics suggest a variant of Adie's syndrome.
The absence of a mydriatic phase challenges the conventional presentation of Adie's syndrome.

Implications:

This case suggests that primary miotic Adie's pupils may exist as a distinct clinical entity.
It expands the spectrum of Adie's syndrome presentations, particularly in cases with early and bilateral involvement.
Further research is warranted to understand the underlying pathophysiology of this variant.

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