The Holmes-Adie pupil is large and irregular.
- 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