Holmes-Adie syndrome (HAS) is a neurological disorder that affects the eye’s pupil and the autonomic nervous system. A larger pupil size than the normal size characterizes this disorder. In this disorder, the pupil slowly constricts in bright light. This type of affected pupil is known as the tonic pupil. The absence of deep tendon reflexes is another important characteristic of this disorder. Read on to know more about Holmes-Adie syndrome.
Holmes-Adie syndrome is usually a result of bacterial or viral infection that leads to inflammation. It damages the neurons in the ciliary ganglion and spinal ganglion. The ciliary ganglion is the area of the brain that coordinates eye movements, whereas the spinal ganglion is the area involved in the autonomic nervous response. This generally begins in one eye and gradually involves the other eye.
Clinical Features of Holmes-Adie Syndrome
The clinical features of this neurological disorder include:
- Unilateral in 80 percent cases
- Decreased tendon reflexes
- Dilated pupil in early stages
- Decreased direct and consensual light reflex
- Pupil slowly constricts in bright light known as tonic pupil
- Hypersensitivity to G pilocarpine solution (0.12%)
- Decreased accommodation reflex
- Patients are mainly young women
Treatment for Holmes-Adie Syndrome
Doctors prescribe reading glasses to compensate for impaired vision in the affected eye. Also, pilocarpine drops are prescribed to constrict the dilated pupil. Three drops should be applied every day. To treat the excessive sweating, a surgery called thoracic sympathectomy is recommended. In this procedure, the sympathetic nerve involved is severed.
Prognosis
This neurological disorder is not disabling or life-threatening. Loss of the deep tendon reflexes is irreversible. Some of the symptoms may gradually progress. In most cases, glasses and pilocarpine drops can improve impaired vision.
