Adie's Pupil (Holmes-Adie syndrome) – Symptoms, Causes, Diagnosis & Treatment

Medically reviewed by Sharon Copeland on 20th May 2022

Adie’s pupil (also referred to as Holmes-Adie syndrome, Adie syndrome or Adie’s tonic pupil) is a neurological condition that affects the nervous system and the eye’s pupil.

The nervous system is responsible for most of our body’s involuntary functions, such as sneezing and sweating. It also controls the pupil of the eye and the way it responds to light. The pupil usually constricts in bright light conditions to let less light in and dilates in lower light to let more light in and enable us to see better.

With Adie's pupil, there is often limited damage to the autonomic nervous system. This is the part of the nervous system responsible for the pupil’s reaction to stimuli. Adie’s pupil affects the pupil’s response to light so that it fails to constrict as normal in bright light settings. Usually, only one eye is affected.

Loss of deep tendon reflexes are also associated with this disorder. When there is both loss of deep tendon reflexes and abnormalities of the pupil, this is known as Adie syndrome. However, when only abnormalities concerning the pupil are present, this is known as Adie's pupil, Adie's tonic pupil or tonic pupil. The term anisocoria can also be used when a person's pupils are different sizes.

What causes Adie's pupil?

The cause of Adie’s pupil is unknown (idiopathic); however, some doctors believe it to be a viral infection whereby the ciliary ganglion, the nerves found in the eye socket that control the pupil are damaged. These nerves carry signals which control the pupil’s response to stimuli such as light and dark conditions.

Others believe it to be cause by an autoimmune disease in which your body’s immune system attacks its healthy tissues, including the nerves that control the pupil. Trauma and ocular surgery are also thought to be possible causes of Adie’s pupil.

Symptoms of Adie’s pupil

Symptoms of Adie’s pupil are distinct and can include having the following:

• One pupil that is larger than the other
• A pupil that fails to constrict (get smaller) in bright light conditions
• Blurry Vision
• Light sensitivity
• Difficulty focusing on close-up tasks such as reading a book, the pupil will take time to constrict
• A slightly oval distorted pupil

Sometimes Adie’s pupil can have the opposite effect, whereby the pupil fails to dilate (widen) in darker conditions.

After months or years, the pupil, which was initially dilated, will shrink becoming smaller than the unaffected pupil. When no longer focusing on nearby objects, the pupil affected may stay smaller than usual or re-dilate at much slower rate than normal.

There are also a couple of non-eye related symptoms, that one may experience with Adie’s pupil. These include:

• Poor deep tendon reflexes (these are involuntary muscle contractions)
• Not having a knee jerk reflex
• Sweating excessively (Ross syndrome)
• Headaches, pain on the face, or fluctuations in an emotional state may also occur

Diagnosis

A comprehensive eye exam can be used to diagnose Adie’s pupil, during which, an ophthalmologist will shine a torch into your eyes to test your pupil’s reactions. They will also investigate to find out when your symptoms became noticeable.

Your ophthalmologist may also instil special eye drops to try and locate the whereabouts in the nerve pathway the problems are occurring.

In some cases, you may be referred to a neuro-ophthalmologist who will conduct more tests to determine whether your condition is sight-threatening.

How do you treat Adie’s pupils?

Treatment for Adie’s pupil varies and usually involves prescribing reading glasses so that one can focus on close-up tasks. Sunglasses can be used for light sensitivity, and in some instances, drugs such as diluted pilocarpine and brimonidine can also be used in patients with Adie syndrome as they work to reduce pupil size.

Does Adie’s Pupil go away?

Adie’s pupil can take a few months to go away; however, in some cases, it may never go away. Nevertheless, Adie’s pupil is not life-threatening or disabling.

Is Adie's pupil serious?

Adie’s pupil is a benign condition, meaning, it is not dangerous or serious. There are very few complications other than the symptoms themselves. While the eyesight of those with Adie's syndrome may change, corrective lenses can be used to fix this.

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