Tonic Pupil

Pupil Disorders

Pupil

Anisocoria

Adie's26

• If you notice one eye having a larger-than-normal pupil that constricts slowly in bright light - you may Adie's syndrome. (optometrists.org)
• Left Adie's Tonic Pupil, which is also known by the name of Adie's Syndrome, is a pathological neurological condition which affects the pupil of the left eye as well as the autonomic nervous system of the body. (epainassist.com)
• The main characteristic of Left Adie's Tonic Pupil is that the left pupil is abnormally larger than normal and there is minimal to no constriction in bright light, which is why it gets it name as Tonic Pupil. (epainassist.com)
• The root cause of Left Adie's Tonic Pupil is not yet known but some studies suggest that this condition may arise as a result of a trauma, a surgical procedure to the left eye, inappropriate blood flow to the left eye, or an infection to the left eye. (epainassist.com)
• Left Adie's Tonic Pupil is a benign and harmless condition and very rarely some form of treatment is required to treat it. (epainassist.com)
• In majority of the cases, reading glasses and eyedrops are the main forms of treatment given for Left Adie's Tonic Pupil. (epainassist.com)
• If the abnormality of the pupil is associated with neurological symptoms like absence of deep tendon reflexes especially in the Achilles tendon then the condition is defined as Adie's Syndrome. (epainassist.com)
• As stated, the root cause of Left Adie's Tonic Pupil is not yet known but some form of trauma to the pupil, a surgical procedure to the eye, or an infection is presumed to cause Left Adie's Tonic Pupil. (epainassist.com)
• Some studies suggest that inflammation or damage to the ciliary ganglion or any type of damage to the postganglionic nerves may be a cause for development of Left Adie's Tonic Pupil. (epainassist.com)
• Damage to the ciliary region may also result from an autoimmune disorder, a tumor, trauma, and potential complications of a surgical procedure to the eye causing Left Adie's Tonic Pupil. (epainassist.com)
• What are the Symptoms of Left Adie's Tonic Pupil? (epainassist.com)
• As stated above, the main characteristic feature of Left Adie's Tonic Pupil is the left pupil being abnormally larger than normal. (epainassist.com)
• At first in Left Adie's Tonic Pupil, only the left pupil is affected but as the disease advances both eyes may get affected. (epainassist.com)
• Some of the other symptoms of Left Adie's Tonic Pupil are excessive sweating. (epainassist.com)
• In some cases, cardiovascular abnormalities may also be noted in cases of Left Adie's Tonic Pupil. (epainassist.com)
• Left Adie's Tonic Pupil is a benign condition and usually does not require any treatment. (epainassist.com)
• At most, the ophthalmologist may prescribe reading glasses or pilocarpine eyedrops for vision impairment caused due to Left Adie's Tonic Pupil. (epainassist.com)
• It also helps with depth perception as well which gets affected due to Left Adie's Tonic Pupil. (epainassist.com)
• These treatments are good enough to restore vision and help the constricted pupil caused by Left Adie's Tonic Pupil. (epainassist.com)
• Another symptom which occurs with Left Adie's Tonic Pupil is excessive sweating and this can be treated by performing a surgical procedure called Thoracic sympathectomy in which the involved sympathetic nerve is excised completely to treat the excessive sweating caused by Left Adie's Tonic Pupil. (epainassist.com)
• Adie's pupil is caused by damage to peripheral pathways to the pupil (parasympathetic neurons in the ciliary ganglion that cause pupillary constriction to bright light and with near vision). (wikipedia.org)
• Adie's tonic pupil is usually associated with a benign peripheral neuropathy (Adie syndrome), not with syphilis. (wikipedia.org)
• Adie's tonic pupil in primary Sjögren syndrome. (nih.gov)
• If all tests are negative, the condition is called Adie's Tonic Pupil. (odpalace.com)
• Clinical Features of Adie's Tonic Pupil: A Retrospective and Cross-Sectional Study. (jkos.org)
• This can be seen in conditions like Horner's syndrome or Adie's tonic pupil. (rthm.com)

Deep tendon reflexes1

• It is distinguished by one eye having a larger-than-normal pupil that constricts slowly in bright light (tonic pupil), as well as the absence of deep tendon reflexes, most commonly in the Achilles tendon. (optometrists.org)

Anisocoria7

• Adie syndrome Anisocoria Cycloplegia Marcus Gunn pupil Miosis Neurosyphilis Parinaud's syndrome Syphilis Digre, Kathleen A. (1986). (wikipedia.org)
• This feature may present clinically as anisocoria (pupils of different size). (dermnetnz.org)
• Unequal pupil size is called anisocoria. (merckmanuals.com)
• Physiologic anisocoria is pupils that are naturally different in size. (merckmanuals.com)
• Neuro-ophthalmologists assess pupillary abnormalities, such as anisocoria (unequal pupil size) or abnormal pupillary responses, which may indicate underlying neurological issues like Horner's syndrome or Adie's tonic pupil. (rthm.com)
• Dysfunction in the pupillary reflexes may occur, leading to abnormalities in the size (anisocoria) or reactivity of the pupils. (rthm.com)
• The term anisocoria refers to pupils that are different sizes at the same time. (idairco.com)

Autonomic nervou1

• Adie syndrome is a neurological disorder that affects the autonomic nervous system, resulting in one pupil of the eye being larger than the other. (optometrists.org)

Abnormally2

• Tonic pupil or Adie syndrome Tonic pupil is where one pupil will appear abnormally large in light, taking a long time to constrict. (idairco.com)
• People with Horner's syndrome have one abnormally large pupil. (idairco.com)

Ciliary3

• PURPOSE: To present a case of tonic pupil associated with enhancement in the region of the ciliary ganglion on magnetic resonance imaging in a patient with sarcoidosis. (psu.edu)
• CONCLUSIONS: Tonic pupil may be a manifestation of sarcoidosis, and in such cases, MRI may show enhancement at the level of the ciliary ganglion. (psu.edu)
• Tonic pupil results from damage to the ciliary ganglion or postganglionic parasympathetic nerve fibres. (dermnetnz.org)

Constrict with near vision2

• In the 1950s, Loewenfeld distinguished between the two types of pupils by carefully observing the exact way in which the pupils constrict with near vision. (wikipedia.org)
• The accommodation pathways - pathways to the Edinger-Westphal nucleus that cause the pupils to constrict with near vision - are thought to be spared because of their more ventral course in the brainstem. (wikidoc.org)

Dilate or constrict1

• Usually, the pupils in each eye dilate or constrict at the same time. (idairco.com)

Right pupil4

• METHODS: A 52-year-old woman with sarcoidosis had a right pupil exhibiting sectoral palsy to light and light-near dissociation. (psu.edu)
• Slit-lamp examination revealed normal anterior and posterior segments except for vermiform movements of the right pupil with a temporal hyporeactive flat area. (bvsalud.org)
• A 55-year-old woman noticed that her right pupil was oddly shaped, associated with a mild ache. (stanford.edu)
• The right pupil was elongated (points at 11:00 and 5:00) and tonic (figure 2). (stanford.edu)

Bilateral6

• Bilateral tonic pupils: Holmes Adie syndrome or generalised neuropathy? (nih.gov)
• To compare the pupil signs in patients with bilateral pupillotonia caused by Holmes-Adie syndrome or generalised peripheral neuropathy. (nih.gov)
• Argyll Robertson pupils (AR pupils) are bilateral small pupils that reduce in size on a near object (i.e., they accommodate), but do not constrict when exposed to bright light (i.e., they do not react). (wikipedia.org)
• The pathophysiologic mechanism which produces an Argyll Robertson pupil is unclear, but is believed to be the result of bilateral damage to the pretectal nuclei in the midbrain. (wikipedia.org)
• Tonic pupil usually affects one pupil first, before becoming bilateral with time. (dermnetnz.org)
• Sometimes the seizures stay only in one part of the brain, while at other times, the seizures can turn into bilateral tonic clonic seizures , which affect the whole brain. (medlineplus.gov)

Horner's1

• What causes a large pupil with Horner's syndrome? (idairco.com)

Clonic seizures1

• Severe tonic-clonic seizures occurred and were followed by periods of apnea. (cdc.gov)

Dilation6

• The condition causes one pupil's abnormal dilation although sometimes both pupils are larger than usual, which can cause bright light pain. (nccmed.com)
• Your pupils can be large for variety of reasons including dilation, household chemical, drugs, or a dark room. (idairco.com)
• Enlarged pupils will be the result of dilation, while pinpoint pupils are the result of constriction. (idairco.com)
• We investigated linear and quadratic relationships between the evoked EEG along these projections and both prestimulus (baseline) and poststimulus (evoked dilation) pupil diameter measurements. (columbia.edu)
• We found no relationships between evoked EEG and evoked pupil dilation, which is often associated with evoked (phasic) LC activity. (columbia.edu)
• We also investigated the relationship between these pupil measures and prestimulus EEG alpha activity, which has been reported as a marker of attentional state, and found a negative linear relationship with evoked pupil dilation. (columbia.edu)

Constriction3

• A pupillary abnormality characterized by a poor pupillary light reaction, reduced accommodation, iris sector palsies, an enhanced pupillary response to near effort that results in a prolonged, "tonic" constriction, and slow pupillary redilation. (wakehealth.edu)
• The older literature on AR pupils did not report the details of pupillary constriction (brisk vs. tonic) that are necessary to distinguish AR pupils from tonic pupils. (wikipedia.org)
• The AR pupil is thought to be caused by damage to central pathways for pupillary constriction. (wikidoc.org)

Unequal7

• If pupil sizes are very unequal, a person may notice the discrepancy. (merckmanuals.com)
• More often, unequal pupils are noticed only during a doctor's examination. (merckmanuals.com)
• Unequal pupils themselves usually cause no symptoms, but occasionally a person may have trouble focusing on near objects. (merckmanuals.com)
• These more noticeable symptoms are often the reason people seek medical care rather than the unequal pupils. (merckmanuals.com)
• Eye disorders that cause unequal pupils include birth defects and eye injury. (merckmanuals.com)
• Inflammation of the iris (iritis) and certain types of glaucoma cause unequal pupils, but this finding is usually overshadowed by severe eye pain. (merckmanuals.com)
• What causes temporary unequal pupil size? (idairco.com)

Left pupil2

• The left pupil constricts very slowly when in bright light or other stimuli. (epainassist.com)
• Her left pupil was round and reactive (figure 1). (stanford.edu)

Syndrome12

• Infrared video pupillographic techniques were used to measure a number of pupil variables in patients with Holmes-Adie syndrome, generalised neuropathy (various aetiologies) and healthy age-matched control subjects. (nih.gov)
• In Adie syndrome, the pupil usually remains dilated even in the presence of bright light. (optometrists.org)
• While Ross's syndrome is technically the combination of decreased sweating, missing reflexes, and weak pupil responses, some clinicians may describe this condition as a variant of Adie syndrome. (optometrists.org)
• This uncommon syndrome involves vertical gaze palsy associated with pupils that "accommodate but do not react. (wikipedia.org)
• Due to the lack of detail in the older literature and the scarcity of AR pupils at the present time, it is not known whether syphilis can cause Parinaud syndrome. (wikipedia.org)
• Incomplete Ross syndrome may not show the constricted tonic pupil(s) on initial presentation, although it is sometimes the reason for seeking medical attention. (dermnetnz.org)
• Horner Syndrome Horner syndrome affects one side of the face, causing the eyelid to droop, the pupil to become small (constricted), and sweating to decrease. (merckmanuals.com)
• Horner syndrome refers to the combination of a constricted pupil, drooping eyelid, and loss of sweating around the affected eye. (merckmanuals.com)
• An ocular syndrome marked by Adie pupil and absent or lessened Achilles tendon reflex and knee-jerk reflex. (unboundmedicine.com)
• Adie syndrome, or Adie tonic pupil, is one of the most common causes of an excessive PERRLA test results. (nccmed.com)
• This syndrome causes areas of one or both pupils to become larger, sometimes during or after a migraine episode. (nccmed.com)
• This case is an unusual presentation of a cat's eye Adie-like pupil as the harbinger for ICE syndrome. (stanford.edu)

Constricts2

• Patients present with the pupil of one eye being larger and only slowly constricts in bright light (tonic pupil). (litfl.com)
• When your pupil shrinks (constricts), it's called miosis. (idairco.com)

Parasympathetic1

• This condition is associated with injury to the postganglionic parasympathetic innervation to the pupil. (wakehealth.edu)

Disorders1

• Thus, people with nervous system disorders that affect the pupil often also have a drooping eyelid, double vision, and/or visibly misaligned eyes. (merckmanuals.com)

Pilocarpine2

• Doctors may provide eye drops containing pilocarpine, a medicine that might help constrict a pupil that has become too dilated. (optometrists.org)
• Tonic pupils were ruled out with pilocarpine 0.1% testing. (bvsalud.org)

Responses1

• Regardless of aetiology, the patients generally had pupil signs typical of pupillotonia (small dark diameters, large light diameters, tonic near responses, attenuated light responses with light-near dissociation, and sector palsy). (nih.gov)

React6

• In general, pupils that accommodate but do not react are said to show light-near dissociation (i.e., it is the absence of a miotic reaction to light, both direct and consensual, with the preservation of a miotic reaction to near stimulus (accommodation/convergence). (wikipedia.org)
• Thompson and Kardon summarize the present view: The evidence supports a midbrain cause of the AR pupil, provided one follows Loewenfeld's definition of the AR pupil as small pupils that react very poorly to light and yet seem to retain a normal pupillary near response that is definitely not tonic. (wikipedia.org)
• A patient whose pupil "accommodates but does not react" almost always has a tonic pupil, not an AR pupil. (wikipedia.org)
• In such people, both pupils react normally to light and darkness and there are no symptoms. (merckmanuals.com)
• They were formerly known as "prostitute's pupils" because of their association with syphilis and because, like a prostitute, they "accommodate but do not react. (wikidoc.org)
• Pupils that "accommodate but do not react" are said to show light-near dissociation . (wikidoc.org)

Pupillary1

• To settle the question of whether the AR pupil is of central or peripheral origin, it will be necessary to perform iris transillumination (or a magnified slit-lamp examination) in a substantial number of patients who have a pupillary light-near dissociation (with and without tonicity of the near reaction), perhaps in many parts of the world. (wikipedia.org)

Syphilis5

• The exact relationship between syphilis and the two types of pupils (AR pupils and tonic pupils) is not known at the present time. (wikipedia.org)
• It is not known whether neurosyphilis itself (infection by Treponema pallidum) can cause tonic pupils, or whether tonic pupils in syphilis simply reflect a coexisting peripheral neuropathy. (wikipedia.org)
• The AR pupil was named after Douglas Moray Cooper Lamb Argyll Robertson , a Scottish ophthalmologist who noted the association with syphilis in 1869. (wikidoc.org)
• [2] When serological tests for syphilis became available, patients with AR pupils usually tested positive for syphilis. (wikidoc.org)
• The AR pupil became known as a reliable clinical sign of syphilis. (wikidoc.org)

Temporal1

• In the normal adult fissure, the highest point of the upper lid is just nasal to the center of the pupil, while the lowest point of the lower lid is just temporal to the center of the pupil. (medscape.com)

Bright light4

• Pupils get larger (dilate) in dim light and smaller (constrict) in bright light. (merckmanuals.com)
• If the larger pupil is abnormal, the difference between pupil sizes is greater in bright light. (merckmanuals.com)
• These light-sensitive pathways allow the pupil to constrict to bright light. (wikidoc.org)
• Pupils are large in the dark to let more light in and small in bright light. (idairco.com)

Pathways2

• These pathways carry nerve impulses to the pupil and to the muscles that control the eye and eyelid. (merckmanuals.com)
• Specifically, the AR pupil is thought to be caused by selective damage to pathways from the retina to the Edinger-Westphal nucleus . (wikidoc.org)

Slowly1

• A usually unilateral ocular condition in which the affected pupil is larger than the normal one, dilates slowly in accommodation-convergence reflexes, and reacts slowly and only after lengthy exposure to light or dark. (unboundmedicine.com)

Prevalence2

• However, significant differences were found in the prevalence and magnitude of several pupil variables in the two patient groups. (nih.gov)
• When penicillin became widely available in the 1940s, the prevalence of AR pupils (which develop only after decades of untreated infection) decreased dramatically. (wikipedia.org)

Corneal1

• Secondary outcomes included visual acuity, epiretinal membrane formation, the presence of cystoid macular oedema, tonic pupil and corneal epithelial defects. (biomedcentral.com)

Iris1

• A scratch or other eye injury can damage the muscles in the iris, causing irregularly shaped pupils. (nccmed.com)

Cyanotic1

• Within 15 minutes of the call, emergency medical personnel arrived and found the younger man unresponsive and cyanotic with mild tachycardia, dilated pupils, and profuse salivation. (cdc.gov)

Light10

• In general, changes in light cause the pupils to shrink or expand. (optometrists.org)
• Light glare and depth perception may be improved as a result of restricting the size of the affected pupil. (optometrists.org)
• The pupil fails to change size on exposure to light but shows the normal size change when accommodating from far vision to close. (dermnetnz.org)
• Usually both pupils are about the same size and respond to light equally. (merckmanuals.com)
• Pharmacological - Recent onset with both pupils still reactive to light. (odpalace.com)
• Healthy pupils work by dilating to let more light in or restrict to let less light in. (nccmed.com)
• Healthy pupils get smaller in bright or direct light, as well as when a person focuses on something very close to their eyes. (nccmed.com)
• If your pupils stay small even in dim light, it can be a sign that things in your eye aren't working the way they should. (idairco.com)
• Primarily, the pupils dilate (get bigger) or constrict (get smaller) to control the amount of light that enters the eyes. (idairco.com)
• Pupils, or the black parts at the center of the eyes, change size to regulate the amount of light entering the eye. (idairco.com)

Abnormal2

• Either the larger or the smaller pupil may be the abnormal one depending on the cause. (merckmanuals.com)
• If the smaller pupil is abnormal, the difference is greater in the dark. (merckmanuals.com)

Midbrain2

• It is not known whether AR pupils are any different from the pupils seen in other dorsal midbrain lesions. (wikipedia.org)
• If the pupils are oval or another odd shape, this may be due to damage to the pupil fibers that attach in the midbrain. (nccmed.com)

Larger3

• Often, the larger pupil is unable to constrict normally. (merckmanuals.com)
• Having one pupil larger than another pupil. (odpalace.com)
• If one pupil is larger than the other, this may signal a problem. (nccmed.com)

Occur1

• Tonic pupils can occur in neurosyphilis. (wikipedia.org)

Muscles1

• The muscles, nerves and brain regions that control the pupils must all function well to get normal PERRLA test results. (nccmed.com)

20181

• 21/02/2018 · In other words, during exploration the pupil is large but less responsive, a pattern that mirrors neural activity of the LC (Aston-Jones & Cohen, 2005). (cardactivation.org)

Naturally1

• Why are my pupils so naturally large? (idairco.com)

Condition2

• Argyll Robertson pupils were named after Douglas Argyll Robertson (1837-1909), a Scottish ophthalmologist and surgeon who described the condition in the mid-1860s in the context of neurosyphilis. (wikipedia.org)
• For the open-loop condition (obtained using 0.5 mm pinhole pupils), binocular accommodation and tonic vergence (distance heterophoria through pinhole pupils) were determined at frequent intervals when binocular fixation was sustained at 4M for 20 min. (uwaterloo.ca)

Small2

• Why Is My Pupil Small? (optometrists.org)
• When to see a doctor about small pupils? (idairco.com)

Unusual1

• If the shape of the pupils is unusual, this could signify an injury to the eye. (nccmed.com)