MRCEM Notes

Holmes-Adie pupil

Holmes-Adie pupil is a benign condition most commonly seen in women. It is one of the differentials of a dilated pupil.

Overview
  • unilateral in 80% of cases
  • dilated pupil
  • once the pupil has constricted it remains small for an abnormally long time
  • slowly reactive to accommodation but very poorly (if at all) to light

Holmes-Adie syndrome
  • association of Holmes-Adie pupil with absent ankle/knee reflexes
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