Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China (mainland).
Med Sci Monit. 2022 Mar 8;28:e934657. doi: 10.12659/MSM.934657.
Adie's pupil, also called tonic pupil, is mainly seen in young women. Most patients have unilateral eye involvement. The pupil of the affected side is significantly larger than that on the healthy side. The direct and indirect light reflection from the pupil on the affected side disappears. The pupil on the affected side is sensitive to low concentrations of pilocarpine. The pathogeneses of Adie's pupil are complex, some of which are insidious and lack corresponding specific diseases. Through a literature review, we found that Adie's pupil is mainly associated with infectious diseases, most commonly syphilis, followed by immune diseases and paraneoplastic syndromes. The ophthalmological symptoms and pupil abnormalities can disappear after active treatment of the primary disease. Pilocarpine can be used to treat ophthalmologic symptoms, such as blurred vision, for which patients might visit an ophthalmologist or neurologist. It is essential for clinicians to improve their understanding of the disease to avoid misdiagnosis. Differential diagnosis between Adie's pupil, oculomotor nerve palsy, anticholinergic drug overdose, Argyll-Robertson pupil, and congenital mydriasis need to be identified by the physician. Here, the clinical manifestations, pathogenesis, relationship between Adie's pupil and diseases, and differential diagnosis of Adie's pupil are reviewed.
阿狄瞳孔，也称强直性瞳孔，主要见于年轻女性。大多数患者单侧眼受累。患侧瞳孔明显大于健侧，直接和间接光反射消失。患侧瞳孔对低浓度毛果芸香碱敏感。阿狄瞳孔的发病机制复杂，部分病因隐匿，缺乏相应的特异性疾病。通过文献复习发现，阿狄瞳孔主要与感染性疾病相关，以梅毒最为常见，其次为免疫性疾病和副肿瘤综合征。积极治疗原发病后，眼疾症状和瞳孔异常可消失。毛果芸香碱可用于治疗视力模糊等眼科症状，患者可能会因此就诊于眼科或神经内科。临床医生提高对该病的认识，避免误诊至关重要。需要医生对阿狄瞳孔、动眼神经麻痹、抗胆碱能药物过量、Argyll-Robertson 瞳孔和先天性扩瞳进行鉴别诊断。现就阿狄瞳孔的临床表现、发病机制、与疾病的关系及鉴别诊断进行综述。
