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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 837-838

An unusual case of pediatric isolated simultaneous bilateral Adie's tonic pupil


Department of Pediatric Ophthalmology and Strabismus, M M Joshi Eye Institute, Hubli, Karnataka, India

Date of Submission23-Apr-2021
Date of Acceptance08-Jun-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Deepti Joshi
M M Joshi Eye Institute, Gokul Road, Hosur, Hubli, Karnataka - 580 021
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_968_21

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  Abstract 


Keywords: Adie's tonic pupil, bilateral, isolated, pediatric, simultaneous


How to cite this article:
Joshi D, Krishnaprasad R, Mahajan S, Agrawal A. An unusual case of pediatric isolated simultaneous bilateral Adie's tonic pupil. Indian J Ophthalmol Case Rep 2021;1:837-8

How to cite this URL:
Joshi D, Krishnaprasad R, Mahajan S, Agrawal A. An unusual case of pediatric isolated simultaneous bilateral Adie's tonic pupil. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 26];1:837-8. Available from: https://www.ijoreports.in/text.asp?2021/1/4/837/327715



Adie's pupil is an efferent pupillary defect resulting from an injury to the post-ganglionic parasympathetic nerves.[1] It is usually a unilateral condition reported in young women with underlying local orbital and systemic factors[2],[3],[4],[5] but the occurrence of isolated bilateral simultaneous Adie's tonic pupil in a 10-year-old child calls for a detailed workup.

A 10-year-old girl presented with a 1-month history of photophobia and blurring of near vision. She had no other ocular/systemic complaints. On examination, she was found to have 20/20 and N24 vision in each eye. A slit-lamp examination revealed bilaterally dilated pupils with segmental vermiform contractions of the iris. The rest of the ocular examination was normal.

With the patient focusing on a distant target, the pupillary diameter was 8 mm in both eyes [Figure 1]a. The patient demonstrated a light near dissociation with no response to light stimulus bilaterally [Figure 1]b, but on looking at a near target, the pupillary diameter was 7 mm in both eyes [Figure 1]c. In a dimly lit room, after the instillation of 0.125% pilocarpine, an examination after 30-minutes revealed a pupillary diameter of 3 mm in both eyes [Figure 1]d.
Figure 1: (a) Bilateral dilated pupils at presentation; (b) Pupils demonstrating no response to light stimulus; (c) Minimal constriction of pupils to 7 mm on near reflex; (d) Bilateral constriction (deneravation supersensitivity) to 0.125% pilocarpine

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A detailed neurological examination including the deep tendon reflexes was within normal limits. The autonomic function was assessed by the measurement of cardiovascular reflexes. Changes in systolic blood pressure and heart rate after Valsalva, deep breathing, and change of posture were recorded and found to be within normal limits. Magnetic resonance imaging of the brain and lab investigations did not reveal any abnormality. She was counseled regarding the condition and was prescribed +2.5D for both the eyes for near work as a bifocal.


  Discussion Top


Mydriasis in pediatric age is often viewed as a worrying sign. In the absence of other ocular/systemic abnormality, unilateral or bilateral mydriasis could be due to an intracranial cause which has to be ruled out by neuroimaging.

We present a rare case of isolated simultaneous bilateral Adie's pupil in pediatric age. Though our patient did not demonstrate any associated ocular or systemic pathology, nonetheless the need for thorough neurological and systemic investigations in any patient presenting with bilateral simultaneous Adie's pupil cannot be overemphasized.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgments

Our gratitude goes to Dr. Rashmin Gandhi for guiding us in the management of the patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Thompson HS. Adie's syndrome: Some new observations. Trans Am Ophthalmol Soc 1977;75:587-626.  Back to cited text no. 1
    
2.
Baran A, Balbaba M, Demir CF, Ozdemir HH. A case of ross syndrome presented with horner and chronic cough. J Neurosci Rural Pract 2014;5:394-7.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Mayer H. Bilateral tonic pupils secondary to ross syndrome: A case report. J Optom 2014;7:106-7.  Back to cited text no. 3
    
4.
Narang S, Sood S, Malik A. Probable Vogt-Koyanagi-Harada's syndrome associated with tonic pupils. Nepal J Ophthalmol 2010;2:154-6.  Back to cited text no. 4
    
5.
Kim JS, Yun CH, Moon CS. Bilateral tonic (Adie's) pupils in Vogt-Koyanagi-Harada syndrome. J Neuroophthalmol 2001;21:205-6.  Back to cited text no. 5
    


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