Adei's atonic pupil is due to
(B) (Loss of parasympathetic nerve supply) (313- Khurana 5th)ADIE'S TONIC PUPIL - caused by post ganglionic parasympathetic pupillo motor damage* Usually unilateral associated with absent knee jerk, common in young woman* Reaction to light is absent and to near reflex is very slow and tonicComparison bwtween Argyll-Robertson pupil and Adie's pupilFeaturesARPAdie' pupilVisionGoodGoodPupilConstrictedDilated (Anisocoria)LateralityBilateral, may be unilateralUnilateral, may become bilateralEffect of illuminationNilLarger in bright lightLight reflex (Direct and consensualAbsentAbsent /poorNear reflex (Accomodation)BriskTonicAtropineNo mydriasisMydriasisMioticConstrictConstrict with, very weak solutionLesionPretectalCiliary ganglionARP- first described in neuro-syphilis, but this may be seen in several conditions affecting the midbrain including Encephalitis, CVA, M.S etcHutchinson's pupil- developed after the head injury (H tor H)There is widely dilated immobile pupil on the same side as the head injury. Both the direct and the concensual reflexes to light are lost
Loss of sympathetic nerve supply
Loss of parasympathetic nerve supply
Vascular ischaemia
Infective neuritis
Neuro-Ophthalmology