BOF: 2.10
A 30-year-old female is admitted
for investigation of headache. On examination of her pupils you notice that
her left pupil is semi-dilated and reacts slowly to both light and
accommodation. Her visual acuity is normal, there is no field defect, no
ptosis and eye movements are normal with no nystagmus or diplopia. Examination
of the fundus does not reveal papilloedema. The pupillary abnormality in this
patient is due to:
a)
Holmes-Adie syndrome
b)
Argyll-Robertson syndrome
c)
Horner’s syndrome
d)
3rd nerve palsy
e)
Relative afferent pupillary defect
Answer:
a)
The Holmes-Adie syndrome refers to
a myotonic pupil, which reacts very slowly (or there is no reaction) to light
and convergence. It is commoner in young females. It may be unilateral or
bilateral. It may be associated with absence or depression of the tendon
reflexes and rarely anhidrosis of the limbs.
It is due to denervation of the ciliary ganglion. The cause is not
known.
