This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages without signing in

Adie's pupil

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The Holmes-Adie pupil is large and irregular.

Pupillary constriction:

  • to light is slow and incomplete
  • to accomodation is relatively normal
  • once the pupil has constricted it remains small for an abnormally long time (tonic pupil)

The Holmes-Adie pupil is considered a variation of normal but is rarely the result of a lesion in the efferent parasympathetic pathway.

The Holmes-Adie syndrome is the association of a Holmes-Adie pupil with absent deep tendon jerks.

Clinical features include:

  • unilateral in 80% of cases
  • dilated pupil in early stages
  • decreased consensual and direct light reflex
  • tonic pupil: pupil slowly constricts in bright light
  • decreased accommodation reflex
  • decreased tendon reflexes
  • hypersensitivity to G pilocarpine solution (0.12%)
  • patients are often young women

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.