Diagnosed Adie's Pupil / Syndrome

[delhi91]

Hi All,

I am a 27 year old male and my problem started 30 days back when I started to feel discomfort in vision coming inside my house from outside during the day (sunshine). It was normal soon after coming inside, and so I didn't bother much initially. The discomfort and time to get normal increased in around a week and I could feel my right eye perceiving more brightness compared to the left (normal) in the sunshine. I felt and thus doubted that my vision has changed and contacted a optometrist to get corrected specs. He could not improve my situation.

Then I contacted an ophthalmologist who told that my right pupil has dilated and suggested to try 2% Pilocarpine for 3 days. My pupil was concentrated by using this solution and I discontinued on his suggestion. My problem came back the next day even more severe and I could not focus on texts with my right eye (and blurred with both eyes).

I was then suggested to contact a Neuro-Ophthalmologist.  He tried 1/8% pilocarpine in both eye's and my right eye concentrated from the full 7mm to 5mm. Left eye was unchanged at 2.5mm. Thus he diagnosed my problem as Adie's Pupil, taking the note that I was not suffering from other neurological symptoms of pain, discomfort etc. He also pointed that this problem may effect other eye. He clearly suggested to accommodate my lifestyle according to the problem and wait for the automatic recovery of my eye in case it is going to happen. Though I can accommodate myself to the problem for time-being, I am left with nothing to do to cure my problem.

I searched the internet for my problem and and got to know that this problem is paired with two other issues, loss of deep tendon reflexes and diaphoresis (excessive sweating), from the below articles:
http://en.wikipedia.org/wiki/Adie_syndrome
http://www.ninds.nih.gov/disorders/holmes_adie/holmes_adie.htm
http://ohiolionseyeresearch.com/QandAarchives.htm#Adie's pupil

I have some concerns regarding my situation and I request your expert advice on it. I would really appreciate if you can through some insight to help understand this problem a bit more.

1) From when I took this into notice around 1 year back, what I remember is that I used to sweat more than other members of my family. The problem maybe even older. Can it happen that this is related symptom that occurred so much time before?

2) Should I go and get my (Deep Tendon) Reflax test? Can I do something to prevent this permanent loss if it has not still occurred?

3) By my foolishness, around a week prior to the first feeling of the discomfort i.e. 38 days before. I happened to stare at sun for a few (around 5) seconds at around 11 AM. My left eye was closed due to the brightness but I kept my right eye open. After a small glimpse of the sun, I moved away. I did not notice any problems in my eye around that day. Can it happen that this act of mine caused the pupil to dilate completely and later being diagnosed as Adie's? Should I re-consult a doctor with this in mind to see if my case was wrongly diagnosed? If this is the case, can I hope for a recovery?

4) Around 50 days back, I was suffering from cough and cold, no fever though. Do this correlate to the triggering of this issue?

5) Same around 50 days back, I watched a 3D anaglyph movie with wrong of color in the right eye. It should be Cyan but I used Blue. Can it have any such Neurological effect?

6) Should I go for a Neurological Test such as CT Scan or MRI?

7) I spend around 10 hours on laptop 5-6 days a week. Can this be linked to my problem?

Any advice to en-light me in this matter will be appreciated. Pls do comment on my doubts and suggest a better approach I should take further in this regard.

Thanks in advance...

[John C Hagan III, MD, FACS, FAAO]

I can't advise you on that. Talk to your MD team.
JCH MD

[Angeluz01]

I will have an MRI scan for Brain(Plain) and Orbit (Plain) next week, but do i need a Pituitary scan too?

Thanks in advance.

[John C Hagan III, MD, FACS, FAAO]

PS locking yourself away will not do you any good. You might go over to one of the depression/psychiatric forums and post your mental state of mind and consider asking for a psychiatric referral to help you deal with your depression and anxiety.

JC MD

[John C Hagan III, MD, FACS, FAAO]

Reduced visual acuity is not part of the Adie's Pupil complex.  MRI is indicated. Would suggest if no answers after MRI done you ask for a referral to a neuro-ophthalmologist.  If you live in USA can also find one near you at www.geteyesmart.org

Your constellations of symptoms is not absolutely diagnostic of any special disease so your team of physicians will likely have to do extensive testing.

JCH MD

[Angeluz01]

I am 41 , male , have black eyes

Got flu 3 month ago , since then have been feeling dizziness for about a month and sometimes lost balance when waking up…

just 5 mins playing Half-Life 2 and I almost throw up… (don't have any motion sickness before …)

About a month ago i notice sudden reduction of visual acuity of both eyes….

I  go to an eye doctor and was diagnosed with Aide's* pupil (R-eye)  …

R pupil 4mm non-react to white light while  L-pupil 3mm did react…

OD 20/60 PH20/30
OS 20/30 PH 20/20

my eye sight some days it's better and some days it's worse ….  good days VA 20/50 , bad day 0 .5/50 ...

Also I had a CT scan of the head and a blood test done because of dizziness , but no other problems have been turned up

I 'll have an MRI Scan  (brain) next week

Right now i feel  living in hell and scare it will be problematic if it happens to my left eye too

this condition  put me into deep depression and make me lock myself away

[John C Hagan III, MD, FACS, FAAO]

=

[delhi91]

Thanks a lot for your suggestions. I really appreciate the help you provided so far.

[John C Hagan III, MD, FACS, FAAO]

no experience with this and signing off
JCH MD

[delhi91]

Thanks again. So, I agree that pinhole glasses or contacts lens are not a preferrable solution.
1) How about Radially Gradient lens with black on the outer boundary and gradually transparent to the center. If I use them in my spectacles, will they give me some focusing relief while reading.
2) can I use them on the normal eye also to balance the ambient light intensity to both the eyes.
3) Is there any specification required while getting them, like the rate of gradience or percentage of opacity at the corners.
4) Finally, any side effects to the affected or normal eye.

Thanks again in advance

[John C Hagan III, MD, FACS, FAAO]

1. No  Pinhole glasses are a waste of money. In some US states they manufactuers have been prosecuted by states attorney general's for fradulent claims.
2. Waste of money
3. see 2
4 Yes, special fit, would require a ophthalmologist or optometrist that specializes in that type of contact
5 Yes pinhole glasses are a total waste of money; contacts carry expense, chance of inablity to wear and small risk of damage to eye especially if not worn and maintained properly.

JCH MD

[delhi91]

Thanks again for the useful information. I tried to accomodate myself to work on computer as before but I am still not comfortable. While browsing the internet, I came across the PINHOLE spectacles, which are said to benefit in some eye problems. I also remember that my ophthalmologist was able to correct my blurring and reading problem by using a pinhole lens.

1) Do you think getting pinhole spectacles for my effected eye will benefit me in reading (preferred) or glare from sunlight.

2) Is there any type of pinhole specs that I should look for. Eg. Single pinhole lens or multi-pinhole.

3) Can an optometrist put a pinhole lens in a regular specs for the effected eye with the other eye having a normal lens.

4) Is contact lens also available to reduce the pupil size suitable for reading.

5) Are there any side effects using the above.

If something can be used, pls do suggest any detail I should know(provide) while getting for that particular lens.

Thanks a lot.

[John C Hagan III, MD, FACS, FAAO]

1. Some recover most don't and are permanent, at least in my experience.
2. See 1
3. No
4. Homeopathy claims to be able to cure everything including cancer, leprosy, fallen arches. There is no scientic evidence it does any good at all except for the incomes of those that sell homeopathic "medicine"
5. Relax there are many things so much worse than Adies. No you cannot speed up or slow down the process.

JCH MD

[delhi91]

Thanks for lot for the information. From you reply, I understand that this problem is not related to staring at sun (point 3) or other visual habits. Pls also advice on the below points.

1) Doctors suggest that the adie's pupil recovers by itself within some time. Is there always some (if not full) improvement in the functionality. Or it can remain the same without any improvement at all.

2) Is there any time frame with-in which it will recover.

3) Will reading books or working on laptop effect the recovery in any manner OR can it affect the other functionality of the eye.

4) Someone suggested me that there is a treatment for this problem in Homeopathy. Do you think Homeopathic medicines can benefit in this problem.

5) Can I do something for a speedy or better recovery.

Thanks in advance.

[John C Hagan III, MD, FACS, FAAO]

1. It is not important to know if you sweat more than other members of your family. The DX is made,
2. No same answer as 1
3.No
4,NO
5.No
6. No
7. no

JCH MD