Critical
An irregularly dilated pupil that has minimal or no reactivity to light. Slow, tonic constriction with convergence, and slow redilation. May have vermiform iris movement and/or sectoral iris sphincter paresis.
NOTE: |
Typically presents unilaterally and more commonly in young women. |
Other
May have an acute onset and become bilateral. The involved pupil may become smaller than the normal pupil over time.
See 10.1, ANISOCORIA.
Idiopathic most commonly. Orbital trauma, surgery, and varicella zoster virus infection are seen frequently. Early syphilis, parvovirus B19, herpes simplex virus, botulism, paraneoplastic syndrome, giant cell arteritis (GCA), panretinal photocoagulation, and neurologic Lyme disease less commonly. Rare associations reported with endometriosis, seminomas, and Sjögren syndrome.
See 10.1, ANISOCORIA, for a general workup when the diagnosis is uncertain.
NOTE: |
The dilute pilocarpine test may occasionally be positive in familial dysautonomia. Hypersensitivity may not be present with an acute Adie pupil and may need to be retested a few weeks later. |