Holmes-Adie Pupil

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Holmes-Adie Pupil

  • benign condition
  • differentiate from IIIrd Cranial Nerve Lesion
  • Tends to occur in young adult women
  • Sudden onset of blurring of near vision occurs as accommodation partially paralysed
  • Pupil slightly dilated, very slow response to accommodation and, especially to light.
  • Knee and ankle jerks also lost in Holmes-Adie syndrome  

Examination

  • General
    • young female
  • Eyes
    • acuity
      • normal
    • Fields
      • normal
    • Pupils
      • unilateral dilated
      • very slow reaction to light
      • slow reaction to accommodation
      • constricts to 2.5% methacholine
    • Movements 
      • Normal
    • Fundi
      • normal
  • Other features
    • decreased ankle-jerks

Differential

 

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