Transient Mydriasis with Cholinergic Supersensitivity: Is it related to Adie Tonic Pupil?

Abstract

We report 3 cases of intermittent mydriasis preceding the demonstration of cholinergic supersensitivity. All 3 patients were women with a history of migrainous headaches, although the headaches were not necessarily associated with the mydriatic episodes. One patient ultimately developed classic Adie pupil. Our cases raise several important questions regarding so-called “benign pupillary dilation of the young” and its relationship with Adie tonic pupil. Our demonstration of probable transient parasympathetic dysfunction suggests that pharmacologic testing with dilute pilocarpine should be considered in patients reporting isolated intermittent mydriasis.

KEYWORDS::

• Adie tonic pupil
• cholinergic supersensitivity
• intermittent mydriasis

ACKNOWLEDGMENTS

This study was supported in part by a departmental grant (Department of Ophthalmology) from Research to Prevent Blindness, Inc., New York, New York, and by CORE grant P30-EY0 6360 (Department of Ophthalmology) from the National Institute of Health, Bethesda, Maryland. Dr. Newman is a recipient of a Research to Prevent Blindness Lew R. Wasserman Merit Award.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.