Adie's pupil and systemic manifestations: a rare unilateral presentation

Area of Science:

• Ophthalmology
• Neurology
• Endocrinology

Background:

• Presents a rare case of Holmes-Adie syndrome in a young woman.
• Highlights the diverse and sometimes subtle clinical manifestations of the syndrome.

Observation:

• Patient experienced blurred vision, particularly with near work.
• Ophthalmic and neurological exams revealed light-near dissociation, vermiform iris movements, and absent deep tendon reflexes.
• Laboratory tests showed mild iron deficiency anemia and low vitamin D3 levels.

Findings:

• Orthopedic evaluation revealed right knee arthritis and patellar chondromalacia.
• Pelvic and lumbar MRI identified an ovarian cyst, periurethral cyst, and sacral hemangioma.
• Diagnosis of Holmes-Adie syndrome was confirmed.

Implications:

• This case underscores the importance of a multidisciplinary approach in diagnosing complex neurological conditions.
• Suggests potential links or co-occurrences between Holmes-Adie syndrome and other seemingly unrelated conditions.
• Emphasizes the role of photochromatic lenses in managing visual symptoms associated with Holmes-Adie syndrome.