Holmes-Adie Syndrome

Holmes-Adie Syndrome can affect the pupil of the eye

Holmes-Adie Syndrome is a neurological disorder of the eyes. The pupil of the eye and the automatic nervous system gets affected by the disease. In Holmes-Adie Syndrome, the pupil of the affected eye is larger than the unaffected eye. The affected pupil constricts slowly when exposed to bright light. Patients with this disease also experience loss of deep tendon reflexes and excessive sweating. The symptoms of Holmes-Adie Syndrome may surface alone or may surface along with other neurological disorders.

Holmes-Adie Syndrome – Causes and symptoms

Women are more susceptible to this disease. It cannot be classified as an inherited disease, excepting in some very rare cases. Holmes-Adie Syndrome is caused by a viral or a bacterial infection. The infection causes damage to the postganglionic fibers of the parasympathetic innervations of the eye. Some medical experts believe that Holmes-Adie Syndrome is an auto-immune disorder. The immune system of the body makes antibodies that in turn affect those specific optic nerves. Arteritis, alcoholism, and diabetes can also cause the disease.

Medical practitioners diagnose the disease by watching out for three classical symptoms. Firstly, one of the pupils appears to be abnormally dilated. This sort of affected pupil is known as tonic pupil. Secondly, there will be loss of deep tendon reflexes. Thirdly, there will be excessive sweating; sometimes, the sweating occurs only in one side of the body. There may be other secondary symptoms as well. Sometimes, patients also suffer from hyperopia and photophobia and may also experience difficulty in reading.

In Holmes-Adie Syndrome, the causal bacterial or viral infection damages neurons of the ciliary ganglion (an area of the brain controlling movements of the eyes) and also the spinal ganglion (an area of the brain that is used for responses of the automatic nervous system). Clinical examination may reveal iris dysfunctions - sectoral paresis of the iris sphincter, or vermiform iris movements. At first, Holmes-Adie Syndrome sets in one eye and often it catches up subsequently with the other eye too. Another characteristic of the disease is that the eye and reflex symptoms do not appear simultaneously at the same time. 

Holmes-Adie Syndrome – Treatment

Prescription of reading glasses is one of the options for the doctors. Reading glasses help in diminishing the effects of the weakened vision of the affected eye. Pilocarpine drops are also prescribed. The drop must be applied at least 3 times daily or as prescribed by the doctor to the affected eye to constrict the dilated pupil. The ultimate treatment of excessive sweating is Thoracic Sympathectomy. Here, the involved nerve that causes the excessive sweating is severed. 

It is to be noted that Holmes-Adie Syndrome is not a life-threatening disease at all. It does not lead to permanent disability either. However, the loss of deep tendon reflexes seems to remain permanent. Unfortunately, the disorder may progress with time. For most of the patients though, Pilocarpine drops and reading glasses seem to be enough for tackling the disease. In a case study, it has also been observed that Holmes-Adie Syndrome is associated with high-altitude pulmonary edema and low chemo responses to hypoxia. Holmes-Adie Syndrome has attacked patients suffering from other diseases such as, migraine, syphilis, Lyme borreliosis, herpes simplex and parvovirus B19 infection. Even it has occurred to patients suffering from Human Immunodeficiency Virus (HIV) infections. 

Holmes-Adie Syndrome Research

Several institutes are engaged in active research and development in this area. The main focus of these research programs are - finding better ways of prevention of the disease, its treatment methodologies, and about disorders faced by patients.

The National institute of Neurological Disorders and Stroke (NINDS) is an active research institute in this field. The National Institutes of Health (NIH) also conduct researches on Holmes-Adie Syndrome in their laboratories. The NIH also facilitates more active research works in other institutes by providing them with adequate grants. We can hope that Holmes-Adie Syndrome can be prevented and treated better in the days ahead.

Related Links:

Search Local Eye Surgeons