HOME PRODUCTS SERVICES COMPANY CONTACT FAQ

Tonic Pupil

Subscribe to New Research on Tonic Pupil

A pupillary abnormality characterized by a poor pupillary light reaction, reduced accommodation, iris sector palsies, an enhanced pupillary response to near effort that results in a prolonged, "tonic" constriction, and slow pupillary redilation. This condition is associated with injury to the postganglionic parasympathetic innervation to the pupil. (From Miller et al., Clinical Neuro-Ophthalmology, 4th ed, pp492-500)

Also Known As:

Myotonic Pupil; Pupillotonia; Tonic Pupil, Local; Tonic Pupil, Neuropathic; Adie Pupil; Adies Pupil; Myotonic Pupils; Neuropathic Tonic Pupil; Neuropathic Tonic Pupils; Pupil, Adie's; Pupil, Local Tonic; Pupil, Myotonic; Pupil, Neuropathic Tonic; Pupillotonias; Pupils, Adie's; Pupils, Local Tonic; Pupils, Myotonic; Pupils, Neuropathic Tonic; Pupils, Tonic; Tonic Pupils; Tonic Pupils, Local; Tonic Pupils, Neuropathic; Adie's Pupil; Pupil, Tonic

Networked: 64 relevant articles (2 outcomes, 1 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Miosis
2.	Tabes Dorsalis
3.	Adie Syndrome
4.	Tonic Pupil
5.	Oculomotor Nerve Diseases (Oculomotor Nerve Palsy)

Experts

1.	Tafakhori, Abbas: 2 articles (03/2012 - 03/2011)
2.	Aghamollaii, Vajiheh: 2 articles (03/2012 - 03/2011)
3.	Bremner, Fion: 2 articles (03/2011 - 09/2008)
4.	Yamamoto, M: 2 articles (12/2000 - 02/2000)
5.	Misu, K: 2 articles (12/2000 - 02/2000)
6.	Hattori, N: 2 articles (12/2000 - 02/2000)
7.	Yoshihara, T: 2 articles (12/2000 - 02/2000)
8.	Takegami, T: 2 articles (12/2000 - 02/2000)
9.	Sobue, G: 2 articles (12/2000 - 02/2000)
10.	Kitani-Morii, Fukiko: 1 article (01/2015)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Tonic Pupil:

1.	Valproic Acid (Valproate, Semisodium)FDA LinkGeneric 02/01/1987 - "A case of tabes dorsalis with tonic pupils and lightning pains relieved by sodium valproate."
2.	brimonidine (Alphagan)FDA LinkGeneric 10/01/2002 - "The patient started brimonidine 0.2% 1 drop in both eyes every morning, which caused 1.5 to 2.0 mm of pupillary miosis (tonic pupil size 3.0 to 4.0 mm in dim light) and eradicated the ghost images. "
3.	Pilocarpine (Ocusert)FDA LinkGeneric 03/01/2012 - "Onion grating as an alternative to pilocarpine drops in a patient with Adie pupil." 03/01/2011 - "In 0.125% pilocarpine test affected pupil responded significantly and tonic pupil was diagnosed. " 03/01/2010 - "She had early dorsal midbrain syndrome mimicking an Adie's tonic pupil, and cholinergic supersensitivity was demonstrated using topical 0.125% pilocarpine. " 05/01/2005 - "Dilute 0.1% pilocarpine test was positive in both eyes, confirming the suspicion of bilateral tonic pupil. " 04/01/2005 - "We propose the diagnosis of Adie's pupil, which was confirmed by the pilocarpine test (0.125%). "
4.	Fluorescein (Funduscein)FDA LinkGeneric 03/01/1990 - "The patients showed a significant cholinergic supersensitivity in their affected tonic pupils and had normal intraocular penetration of fluorescein through the cornea in both eyes. " 03/01/1990 - "In this study, the degree of intraocular penetration of topical fluorescein was compared with the degree of pilocarpine-induced miosis in six tonic pupils and in seven age-matched normal controls. "
5.	Methacholine Chloride (Methacholine)FDA Link 01/01/1972 - "[Importance of the mecholyl test for the diagnosis of pupillotonia]." 05/01/1964 - "[DISTURBANCES OF ACCOMMODATION IN CASES OF PUPILLOTONIA AND CLINICAL APPLICATION OF ACETYL-BETA-METHYLCHOLINE (MECHOLYL) TO THEM]." 01/01/1954 - "[Differential diagnosis of pupillotonia with special reference to the mecholyl test]." 03/01/1990 - "Cholinergic supersensitivity of the iris sphincter helps to make the diagnosis of "tonic pupil." Because uncertain responses sometimes occur with mecholyl 2.5%, dilute solutions of pilocarpine are often used. " 03/01/1978 - "In patients with unilateral Adie's syndrome, we compared the relative supersensitivity of the tonic pupil to methacholine hydrochloride (Mecholyl 2.5%) and pilocarpine 0.125%. "
6.	AutoantibodiesIBA 03/01/2004 - "To the best of our knowledge, to date no case of bilateral tonic pupils has been published due to a paraneoplastic disorder with evidence of autoantibodies. " 08/01/1990 - "It is concluded that two diseases of the patient may be probably caused by multiple organ- or tissue-specific autoantibodies, in addition to pathogenetic significance of Adie's pupil." 02/01/2008 - "In the tonic pupil (Adie syndrome) autoantibodies may play a role, in exceptional cases it might represent a paraneoplastic disorder."
7.	AntibodiesIBA 02/01/2008 - "Anti-Hu antibodies may be associated with tonic pupils. " 09/21/2000 - "High levels of the binding antibodies correlated with more severe autonomic dysfunction (including the presence of tonic pupils). " 03/01/2004 - "A unilateral tonic pupil is usually a benign finding but has also been described in the context of paraneoplastic syndromes, in some cases associated with anti-Hu antibodies. " 03/01/2004 - "Bilateral tonic pupils with evidence of anti-hu antibodies as a paraneoplastic manifestation of small cell lung cancer."
8.	Myelin P0 Protein (Myelin Protein Zero)IBA 03/01/2011 - "We report a patient with Charcot-Marie-Tooth disease (CMT) due to the p.Ile112Thr mutation in myelin protein zero (MPZ) who presented with a patchy neuropathy with conduction block and tonic pupils. " 03/01/2011 - "Conduction block and tonic pupils in Charcot-Marie-Tooth disease caused by a myelin protein zero p.Ile112Thr mutation." 02/01/2000 - "[Two families of Charcot-Marie-Tooth disease with Adie's pupil, axonal neuropahy and the Thr124Met mutation in the peripheral myelin protein zero gene]."
9.	Cholinergic AgonistsIBA 02/01/1993 - "The aim is to establish whether mechanical properties of the iris affect miotic behavior using a cholinergic agonist and, if so, to define a more specific clinical definition of supersensitivity testing for suspected tonic pupil disorders. " 11/01/1995 - "None of these patients had a tonic pupil or cholinergic agonist-induced pharmacologic mydriasis. "
10.	Phenylephrine (Neo-Synephrine)FDA LinkGeneric 03/01/1986 - "Seventy one percent of sympathetically denervated or decentralized (Horner's) pupils and 41% of parasympathetically denervated ("tonic") pupils are abnormally responsive or "supersensitive" to dilute solutions of phenylephrine and pilocarpine respectively. " 05/01/1990 - "We investigated pupillary responses to parasympathetic (pilocarpine) and sympathetic agents (tyramine, cocaine, and phenylephrine) in a 51-year-old woman with tonic pupils, loss of muscle stretch reflexes in the limbs, and hemifacial loss of sweating and flushing (Ross' syndrome). "

Therapies and Procedures

1.	Denervation 02/01/1998 - "The innervational history and current status of each clock-hour segment of the iris sphincter can be determined using this technique of videographic infrared transillumination, and the progression and pattern of iris denervation and reinnervation can be determined in patients with Adie's pupil. " 12/01/1991 - "In 1958 Ross described a triade consisting of tonic pupils, hyporeflexia and sudomotor denervation. " 07/01/1978 - "The accepted hypothesis for the pathophysiology of tonic pupil syndrome (Adie syndrome) was reexamined in light of recent developments concerning denervation supersensitivity of cholinergically innervated smooth muscle. " 08/01/2000 - "In both cases, pharmacologic testing with dilute pilocarpine confirmed denervation supersensitivity consistent with tonic pupil. " 03/01/2006 - "Adie pupil responded to 0.125% pilocarpine, establishing denervation hypersensitivity of the parasympathetic nerve. "
2.	Osteotomy 11/01/2014 - "We report, to our knowledge, the first case of bilateral Adie's pupil after Le Fort I osteotomy. " 11/01/2014 - "Adie's pupil following Le Fort I maxillary osteotomy: case report." 10/01/1990 - "Adie's pupil following Le Fort I maxillary osteotomy. " 10/01/1990 - "A case is reported of right-sided tonic pupil in isolation (Adie's pupil) following Le Fort I maxillary osteotomy. "
3.	Anesthesia 08/01/1997 - "In addition there were tonic pupils, anesthesia of the corneas, and an accommodative deficit. " 08/01/1997 - "Corneal anesthesia, tonic pupils and accommodative impairment can be features of the Vogt-Koyanagi-Harada syndrome." 01/01/2009 - "Tonic pupil was observed in a 67 year-old patient following a retinal detachment repair with pars plana vitrectomy, endolaser and silicone oil tamponade performed under retrobulbar anesthesia. "
4.	Transplants (Transplant) 10/01/2004 - "The case is reported herein of bilateral subacute angle-closure glaucoma that occurred following coronary artery bypass graft surgery in association with tonic pupils." 10/01/2004 - "Bilateral subacute angle-closure glaucoma in association with tonic pupils post-coronary artery bypass graft."
5.	Bone Marrow Transplantation (Transplantation, Bone Marrow) 12/01/2004 - "Immune recovery disease: a case of interstitial keratitis and tonic pupil following bone marrow transplantation."