ADIE’S SYNDROME: THE CLINICAL CASE
Adie’s syndrome is a combination of certain ophthalmic and neurological disorders that is characterized by pupil rigidity, abnormal pupil reactions and absence of bone-tendon refl exes. Ophthalmic clinical features: constantly enlarged pupil, variability of its diameter from day to day. The disease is usually unilateral (in 85% of cases). There is absence of the pupil reaction to the direct light. Accommodation abnormality is another typical ophthalmological feature of Adie’s syndrome. Convergence decreasing or disappearance is revealed on the diseased side.
The clinical сase of Adie’s syndrome showed that the ophthalmologic examination was the main way to clarify the diagnosis and to distinguish it from other similar pathological conditions.
The differential diagnosis of Adie’s syndrome includes ocular or orbital trauma, Argyll – Robertson syndrome, using cycloplegic medication (direct or indirect) plays its role in differentiation of diagnosis. The main cause of Argyll – Robertson syndrome – is neurosyphilis. Testing with low dose (0,1%) of pilocarpine may constrict the tonic pupil due to cholinergic denervation of supersensitivity. A normal pupil, or enlarged pupil by medication will not constrict with the dilute dose of pilocarpine.
After differential diagnosis the patient with Adie’s syndrome must be examined by a neurologist.
Conclusions: 1. Ophthalmologic examination using 0.1% pilocarpine probe is the main way to clarify and differentiate the diagnosis of Adie’s syndrome.
2. The correct algorithm for diagnostic of pupil reactions, systemic conditions gives the ability to determine the further tactics of treatment and observation.
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