Which are the symptoms of Holmes-Adie Syndrome?

Holmes-Adie Syndrome, also known as Adie's syndrome or tonic pupil, is a rare neurological disorder that primarily affects the eyes. It is characterized by the presence of an enlarged pupil, known as tonic pupil, which reacts slowly to light and accommodates poorly to near vision. This condition typically occurs unilaterally, affecting only one eye, but in some cases, it can be bilateral, affecting both eyes.

The most prominent symptom of Holmes-Adie Syndrome is the presence of a dilated pupil. The affected pupil is often larger than the normal pupil size and may appear irregular in shape. This dilation is caused by the dysfunction of the parasympathetic nerves that control the constriction of the pupil. As a result, the pupil reacts slowly or incompletely to changes in light intensity.

Individuals with Holmes-Adie Syndrome may also experience blurred vision, particularly when transitioning between bright and dim environments. This is due to the impaired ability of the pupil to adjust its size in response to varying light conditions. Additionally, affected individuals may have difficulty focusing on nearby objects, a condition known as poor accommodation. This can lead to problems with reading and other close-up tasks.

Another notable symptom of Holmes-Adie Syndrome is the presence of deep tendon reflex abnormalities. This can manifest as reduced or absent reflexes, particularly in the Achilles tendon. The affected tendon may not respond as expected when tapped with a reflex hammer. These reflex abnormalities are thought to be caused by damage to the autonomic nerves that control reflex responses.

While the dilated pupil and reflex abnormalities are the hallmark features of Holmes-Adie Syndrome, some individuals may also experience additional symptoms. These can include mild to moderate eye pain or discomfort, sensitivity to bright light (photophobia), and difficulty with night vision. Some individuals may also have mild ptosis (drooping of the eyelid) or abnormal sweating in the affected eye or face.

It is important to note that the symptoms of Holmes-Adie Syndrome can vary among individuals. Some individuals may have mild and relatively asymptomatic cases, while others may experience more pronounced symptoms that significantly impact their vision and daily activities. It is advisable for individuals experiencing any of these symptoms to seek medical evaluation and diagnosis from a qualified healthcare professional.