J Korean Ophthalmol Soc.  2008 Dec;49(12):2032-2036.

A Case of Adie's Tonic Pupil Before Presentation of Denervation Hypersensitivity

• Lee KS
• Choi HJ
• Kim HY

Abstract

PURPOSE: Denervation supersensitivity to 0.125% pilocarpine is an important factor in making a diagnosis of Adie's tonic pupil. However, it generally takes several weeks for denervation supersensitivity to manifest after an injury to the nerve ganglion. We report a case of 'acute' Adie's tonic pupil before the manifestation of denervation supersensitivity.
CASE SUMMARY
A 53-year-old man with no significant past medical history visited our clinic, reporting mydriasis of his left eye. Pupil size was 8 mm in the right eye, 3 mm in the left. Loss of both direct/indirect light reflex and light-near reflex were observed. The left pupil did not react to 0.125% Pilocarpine, but constricted in response to 1% pilocarpine. After 5 months, the pupil size did not change, but the pupil constricted in response to 0.125% pilocarpine.
CONCLUSIONS
In an isolated case of dilated pupil, though the pupil did not react to 0.125% pilocarpine, with respect to the Adie's tonic pupil, to check the manifestation of denervation supersensitivity should be needed at regular intervals.

Keyword

Denervation hypersensitivity; Tonic pupil

MeSH Terms

Denervation
Eye
Ganglion Cysts
Humans
Hypersensitivity
Light
Middle Aged
Mydriasis
Pilocarpine
Pupil
Reflex
Tonic Pupil
Pilocarpine

Figure

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  Figure 1. Slit-lamp photograph at one hour after 0.125% pilocarpine instillation in a 53-year-old man with a fifteen-day history of pupil dilation in the left eye at the first visit.

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  Figure 2. Slit-lamp photograph at one hour after 0.125% pilocarpine instillation at five months after the first visit. The patient showed denervation supersensitivity to 0.125% pilocarpine and sector paralysis of the iris at one o’clock in the left eye. (Arrow)

Reference

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