The Tonic Pupil

Accommodation in the Holmes-Adie Syndrome

“…As in the case of the slow pupillary constriction, slow accommodation has been termed tonic. Graveson (1949) reported tonic accommodation for near vision in the majority of his patients. However, other authors found that the greater delay in accommodation occurs for far vision (Markus, 1906;Reitsch, 1925;Holmes, 1931;Adie, 1932;Heersema and Moersch, 1939); the patient is unable to relax accommodation when looking from a close to a distant object.…”

“…In addition to the various abnormalities of the pupil, disturbances of accommodation have been described in the Holmes-Adie syndrome; Kyrieleis (1951) stated that they occurred in more than 20% of cases and Graveson (1949) found them in 16 out of 22 affected eyes. Little attention has been paid to the mechanism of the abnormality of accommodation.…”

“…The delay in accommodating for near or distant vision was also influenced by practice, so that consistent observations were not obtainable. Graveson's (1949) clinical method was therefore used for measuring the delay in accommodation for near vision in the Holmes-Adie patients. A Jaeger test card which could be read comfortably at a distance greater than the near point was chosen (usually J4 to J8).…”