Adie's Syndrome (Pupillotonic Pseudotabes)

William John Adie: the man behind the syndrome

“…The most primitive depictions of the tonic pupil came as early as 1813 by James Ware and 1881 by Hughlings Jackson . However, the more cited and recognized written descriptions of tonic pupil came simultaneously in 1902 when Saenger and Strasburger described it independently. Since then, numerous articles on the tonic pupil have appeared in the medical literature .…”

Adie's Syndrome

“…O. Lowenstein and E. D. Friedman (1942), while acknowledging that tonic pupillary reactions may be caused by peripheral lesions, believe Adie's welldefined syndrome to be due to a heredodegenerative disorder situated in the great autonomie centers of the diencephalon and their connections with the mesencephalon.…”

“…By means of pupillography, O. Lowenstein and E. D. Friedman (1942) have proved, in cases of unilateral pupillo¬ tonia, the existence of a "tonohaptic" reac¬ tion in the nontonic eye. It is, therefore, conceivable that a slight ciliary spasm may equally constitute the only symptom of pupillotonia in an eye which seems to be unaffected.…”

The Tonic Pupil

“…In the present series of cases there is one (Case 8) where the tonic pupil was a direct and isolated sequel to a head injury. Tonic pupil has also been described as a familial disturbance (Dressler and Wagner, 1937;McKinney and Frocht, 1940), and Lowenstein and Friedman (1942) report slight pupillary abnormalities in the mothers of some of their patients.…”

“…The " atypical " forms were less clearly defined but included some forms of internal ophthalmoplegia and complete light rigidity with a tonic convergence reaction. Since Adie's description, this conception of the atypical tonic pupil has been so far enlarged upon that, for example, Lowenstein and Friedman (1942) write, " In atypical cases all the modifications obserVable in pupillary disease both of syphilitic and other causation may be exhibited." Similarly Alajouanine and Morax (1938) claim that between the typical tonic pupil and the Argyll Robertson pupil all intermediary forms are possible.…”