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The tonic pupil may become smaller (miotic) over time which is referred to as "little old Adie's". [5] Testing with low dose (1/8%) pilocarpine may constrict the tonic pupil due to cholinergic denervation supersensitivity. [1] A normal pupil will not constrict with the dilute dose of pilocarpine. [5]
Adie's tonic pupil is usually associated with a benign peripheral neuropathy (Adie syndrome), not with syphilis. [ 6 ] When penicillin became widely available in the 1940s, the prevalence of AR pupils (which develop only after decades of untreated infection) decreased dramatically.
Ross' syndrome consists of Adie's syndrome (myotonic pupils and absent deep tendon reflexes) plus segmental anhidrosis (typically associated with compensatory hyperhidrosis). [1] It was characterized in 1958 [2] [3] by A.T. Ross. [4] By 1992, eighteen cases had been documented. [5]
Adie tonic pupil: Tonic pupil is usually an isolated benign entity, presenting in young women. It may be associated with loss of deep tendon reflex (Adie's syndrome). Tonic pupil is characterized by delayed dilation of the iris, especially after near stimulus, segmental iris constriction, and sensitivity of pupil to a weak solution of pilocarpine.
Adie syndrome [4] is tonic pupil plus absent deep tendon reflexes. Adie syndrome is a fairly common, benign, idiopathic neuropathy that selectively affects the ciliary ganglion and the spinal cord neurons involved in deep tendon reflex arcs.
The Marcus Gunn pupil is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye. [3] In the swinging flashlight test, a light is alternately shone into the left and right eyes. A normal response would be equal constriction of both pupils, regardless of which eye the light is directed at.
Typical symptoms include gastrointestinal dysmotility, orthostatic hypotension, and tonic pupils. [1] Many cases have a sudden onset, but others worsen over time, resembling degenerative forms of autonomic dysfunction. For milder cases, supportive treatment is used to manage symptoms. [2]
Some patients who demonstrate tadpole pupil symptoms also experienced Horner’s syndrome or Adie’s tonic pupil. [5] Tadpole pupil symptoms occur in episodes. Episodes are generally brief and less than 5 minutes, [5] however, some episodes have been reported to last anywhere from 3 to 15 minutes. [1]