Kyu Sung Lee; Hyun Jun Choi; Hye Young Kim

doi:10.3341/jkos.2008.49.12.2032

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Lee, Choi, and Kim: A Case of Adie’s Tonic Pupil Before Presentation of Denervation Hypersensitivity

Original Article

J Korean Ophthalmol Soc 2008;49(12):2032-2036.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.12.2032

A Case of Adie’s Tonic Pupil Before Presentation of Denervation Hypersensitivity

Kyu Sung Lee, M.D., Hyun Jun Choi, M.D., Hye Young Kim, M.D.

National Health Insurance Corporation Ilsan Hospital, Gyeonggi, Korea

Address reprint requests to Hye Young Kim, M.D. Department of Ophthalmology, National Health Insurance Corporation Ilsan Hospital #1232 Baekseok 1-dong, Ilsandong-gu, Goyang-si, Gyeonggi 411-719, Korea Tel: 82-31-900-0590, Fax: 82-31-900-0049, E-mail: khyeye@hanmail.net

Received 24 September 2008 Accepted 12 December 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Denervation supersensitivity to 0.125% pilocarpine is an important factor in making a diagnosis of Adie’s tonic pupil. However, it generally takes several weeks for denervation supersensitivity to manifest after an injury to the nerve ganglion. We report a case of ‘acute’ Adie’s tonic pupil before the manifestation of denervation supersensitivity.

Case summary

A 53-year-old man with no significant past medical history visited our clinic, reporting mydriasis of his left eye. Pupil size was 8 mm in the right eye, 3 mm in the left. Loss of both direct/indirect light reflex and light-near reflex were observed. The left pupil did not react to 0.125% Pilocarpine, but constricted in response to 1% pilocarpine. After 5 months, the pupil size did not change, but the pupil constricted in response to 0.125% pilocarpine.

Conclusions

In an isolated case of dilated pupil, though the pupil did not react to 0.125% pilocarpine, with respect to the Adie’s tonic pupil, to check the manifestation of denervation supersensitivity should be needed at regular intervals.

Keywords: Denervation hypersensitivity, Tonic pupil

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Figure 1.

Slit-lamp photograph at one hour after 0.125% pilocarpine instillation in a 53-year-old man with a fifteen-day history of pupil dilation in the left eye at the first visit.

Figure 2.

Slit-lamp photograph at one hour after 0.125% pilocarpine instillation at five months after the first visit. The patient showed denervation supersensitivity to 0.125% pilocarpine and sector paralysis of the iris at one o’clock in the left eye. (Arrow)

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