Holmes-Adie Syndrome (Adie’s Pupil): An overview of symptoms, causes, diagnosis and treatment

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Holmes Adie Syndrome
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Holmes Adie Syndrome

• Holmes-Adie Syndrome is a neurological disorder
  that affects the pupil of the eye and the
  autonomic nervous system. In Holmes-Adie
  Syndrome, the pupil of the affected eye is larger
  than the unaffected eye. The affected pupil
  constricts slowly when exposed to bright light.
  Patients with this disease also experience loss
  of deep tendon reflexes and excessive sweating.
  The symptoms of Holmes-Adie Syndrome may appear
  alone or along with other neurological disorders.
  Predominantly females between the ages of 20 and
  40 seem to be affected by this eye disease.

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Causes of Holmes-Adie Syndrome

• Holmes-Adie Syndrome cannot be classified as an
  inherited disease barring few cases. The disease
  is caused by a viral or a bacterial infection.
  The infection causes damage to the postganglionic
  fibers of the eye. Some eye experts believe that
  Holmes-Adie Syndrome is an autoimmune disorder.
  The immune system of the body makes antibodies
  that in turn affect those specific optic
  nerves. Arteritis, alcoholism, and diabetes can
  also cause the disease.

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Symptoms

• People with Holmes-Adie Syndrome develop various
  distinct symptoms. The pupil of the affected eye
  first appears larger than the normal eye and
  reacts abnormally to light. At first, the pupil
  reacts slowly during close tasks such as reading
  because the eye begins to lose its close-range
  focusing power. Occasionally, the iris becomes
  de-pigmented, losing most or its entire colour.
  Blurred vision, especially at close range, is
  another common symptom of Holmes-Adie Syndrome,
  as well as excessive sweating.

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Diagnosis of Holmes-Adie Syndrome

• Your ophthalmologist will ask questions to
  determine when your pupil size difference
  or blurry vision became noticeable. Your eye
  doctor will most likely to conduct an eye
  examination. This will include shining a very
  bright light into your eyes to test your pupil
  reactions. He/she may instil special diagnostic
  eye drops to assess the location in the nerve
  pathway that problems may be occurring.

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Treatments

• Prescription of reading glasses is one of the
  options for the ophthalmologists. Reading glasses
  help in reducing the effects of the weakened
  vision of the affected eye. Pilocarpine drops
  must be applied at least 3 times daily or as
  prescribed by the eye doctor to the affected eye
  to constrict the dilated pupil. The ultimate
  treatment of excessive sweating is Thoracic
  Sympathectomy. Here, the involved nerve that
  causes the excessive sweating is
  severed. Holmes-Adie Syndrome is not
  a life-threatening disease. It does not lead
  to permanent disability. However, the loss of
  deep tendon reflexes seems to remain permanent.
  Sadly, Holmes-Adie Syndrome may progress with
  time. For most of the patients Pilocarpine drops
  and reading glasses seem to be enough for
  tackling the disease.

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