An Overview of Adie's Pupil

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Adie’s pupil (also referred to as Holmes-Adie syndrome, Adie’s tonic pupil or Adie syndrome) is a neurological disorder that affects the pupil of the eye and the autonomic nervous system. Patients with Adie's pupil are more likely to be assigned female at birth and between the ages of 20 and 40.

Close-up of a person's eye
Rolando Caponi / EyeEm / Getty Images


People with Adie's pupil usually develop several distinct symptoms. The pupil of the affected eye first appears larger or more dilated than the normal eye and reacts abnormally to light. Initially, the pupil reacts slowly or irregularly during close tasks such as reading because the eye begins to lose its close-range focusing power. After extended near focusing or accommodation, the involved pupil may actually become tonic, remaining constricted long after discontinuing accommodative effort. Occasionally, the iris becomes depigmented, losing most or all of its color. Deep tendon reflexes, such as the classic hammer-to-knee reflex, may also be diminished in those patients that have systemic dysautonomia. Blurred vision, especially at close range, is another common symptom of the disorder, as well as excessive sweating.


Adie's pupil is marked by damage to a special group of nerves called the ciliary ganglion, although the actual cause of the damage is generally unknown. There are many potential causes, which can include bacterial or viral infections, trauma, and ocular surgery that may damage the nerves, but often Adie's pupil is idiopathic, meaning it has no known cause.


Your eye doctor will ask you several questions to determine when your pupil size difference or blurry vision became noticeable. Your healthcare provider will most likely conduct a comprehensive eye examination. This will include shining a very bright light into your eyes to test your pupil reactions. Your healthcare provider may also instill special diagnostic eye drops to assess the location in the nerve pathway where problems may be occurring. You may or may not be referred to a neuro-ophthalmologist for more testing, specifically to determine if the pupil asymmetry (anisocoria) is potentially sight-threatening.


Standard treatment for Adie's pupil usually includes prescribing bifocal or reading glasses to help with near focusing issues. A drug called pilocarpine is sometimes prescribed to reduce the pupil size in people dealing with night driving glare or light sensitivity. Brimonidine, a glaucoma drug, has also been used to reduce pupil size.


A good percentage of people with Adie's pupil recover fully in a few months to within 2 years. In some people, the affected pupil becomes smaller over time and may stay smaller than the normal pupil, and in others, the near pupillary response never fully recovers.


Though Adie’s pupil is not a life-threatening disease, it can be debilitating. Adie's pupil causes premature loss of near-focusing power similar to presbyopia, a condition that occurs around the age of 40. As a result, it can be difficult for a younger patient because one eye focuses just fine and the other does not. Some people may complain of extreme light sensitivity. Others may have a difficult time with night vision or driving at night. Some people with the disorder find that the excessive sweating causes quality of life issues.

A Word From Verywell

If you or a loved one notice that your pupils are not matching in size, a condition known as anisocoria, it's important to see your healthcare provider, who may recommend that you make an appointment with a neuro-ophthalmologist. This added step is to simply make sure that there isn't another reason aside from Adie's pupil causing the difference in pupillary size.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Sarao MS, Sharma S. Adie Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

  2. Sinharoy U, Chakraborty D, Saha S, Mukherjee J. Isolated dilated pupil: Is it adies pupil? Archives of Medicine and Health Sciences. 2016;4(2):233. doi:10.4103/2321-4848.196211

Additional Reading
  • Slmovits TL, Burde R. Neuro-ophthalmology. Year Book Europe Ltd.