Adie syndrome 2959537 225105515 2008-07-11T22:16:34Z 151.56.88.205 {{Infobox_Disease | Name = Adie syndrome | Image = | Caption = | DiseasesDB = 29742 | ICD10 = | ICD9 = {{ICD9|379.46}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D015845 | }} '''Adie syndrome''', sometimes known as '''Holmes-Adie's syndrome''' or '''Adie's Tonic Pupil''', is a [[neurological disorder]] which affects the [[pupil]] of the eye and the [[autonomic nervous system]].<ref name=ninds>{{cite web |url=http://www.ninds.nih.gov/disorders/holmes_adie/holmes_adie.htm |title= Holmes-Adie syndrome Information Page | author= |publisher=National Institute of Neurological Disorders and Stroke|accessdate=2008-01-21 |format= |work=}}</ref> It is caused by damage to the [[postganglionic fiber]]s of the [[parasympathetic nervous system|parasympathetic innervation]] of the eye, usually by a [[viral]] or [[bacterial]] infection which causes [[inflammation]], and characterized by a [[Tonic (physiology)|tonic]]ally [[Mydriasis|dilated]] pupil.<ref name=ninds/> ==Signs and Symptoms== [[Image:Dilated pupil.gk.jpg|thumb|right|200px|This photograph shows an abnormally sized pupil which has been dilated with eye drops]] Adie syndrome presents with three [[hallmark]] symptoms, namely abnormal pupil size ([[mydriasis]]), loss of deep tendon reflexes and [[diaphoresis]].<ref name=ninds/> Other signs may include [[hyperopia]] due to accommodative [[paresis]], [[photophobia]] and difficulty reading.<ref name=stedman>{{cite book | last = | first = | authorlink = | coauthors = | title = Stedman's Medical Dictionary, 27th Edition | publisher = | date = 2000 | location = | pages = | url = | doi = | id = | isbn = 0-683-40007-X}}</ref> ==Diagnosis== Clinical exam may reveal sectoral paresis of the iris sphincter and/or vermiform iris movements. The tonic pupil may become smaller (miotic) over time which is referred to as "little old Adie's".<ref name=fundneuro>{{cite book | last = Haines | first = Duane E. | authorlink = | coauthors = | title = Fundamental Neuroscience, 2nd edition | publisher = | date = 2002 | location = | pages = | url = | doi = | id = | isbn = 0-443-06603-5}}</ref> Testing with low dose (1/8%) [[pilocarpine]] may constrict the tonic pupil due to [[cholinergic]] denervation supersensitivity.<ref name=ninds/> A normal pupil will not constrict with the [[dilute]] dose of pilocarpine.<ref name=fundneuro/> [[CT Scan|CT scans]] and [[MRI]] scans may be useful in the diagnostic testing of [[Focal dystonia|focal]] hypoactive reflexes.<ref name=wrong>{{cite web |url=http://www.wrongdiagnosis.com/a/adie_syndrome/diagnosis.htm |title= Diagnosis of Adie syndrome | author= |publisher= WrongDiagnosis.com|accessdate=2008-01-21 |format= |work=}}</ref> ==Treatment== The usual treatment of a standardised Adie syndrome is to prescribe reading glasses to correct for impairment of the eye(s).<ref name=ninds/> [[Pilocarpine]] drops may be administered as a treatment as well as a diagnostic measure, and should be applied three times daily.<ref name=ninds/> [[Thoracic sympathectomy]] is the definitive treatment of diaphoresis, if the condition is not treatable by [[drug therapy]].<ref name=ninds/> ==Prognosis== Adie's syndrome is not life threatening or disabling.<ref name=ninds/> As such, there is no mortality rate relating to the condition, however loss of deep tendon reflexes is permanent and may progress over time.<ref name=ninds/> ==Epidemiology== It most commonly affects younger women and is unilateral in 80% of cases.<ref name=fundneuro/> ==References== <references/> ==External links== *[http://oddsnsods.camio.co.uk/node/2 Personal experience] *[http://www.mrcophth.com/eyeclipartchua/pupils.html Animation] at mrcophth.com {{Eye pathology}} [[Category:Neurological disorders]] [[Category:Anatomical pathology]] [[Category:Syndromes]] {{Neuroscience-stub}} [[de:Adie-Syndrom]] [[es:Síndrome de Adie]] [[id:Sindrom Adie]] [[it:Pupilla tonica di Adie]] [[nl:Syndroom van Adie]] [[nn:Adies syndrom]] [[pt:Síndrome de Adie]]