Adie's pupil is a neurological condition of unknown origin with unusual, asymmetric presentation known as
anisocoria with the enlarged pupil failing to react to light. It is believed that this pupillary abnormality results from damage to the ciliary ganglion or postganglionic short ciliary nerves. Affected individuals (usually female) may be symptomatic with
photophobia or difficulty reading in the diseased eye. Although most
Adie's pupil cases are idiopathic, previous studies have associated
photocoagulation and
uveitis with symptom onset. To the best of our knowledge, there have been no reports of specific means of preventing
Adie's pupil. We describe a patient who experienced varying severities of
Adie's pupil after separate
laser treatments of the ischemic peripheral retina for
uveitis.
Fluorescein angiography revealed peripheral
retinal nonperfusion in the bilateral eyes of a 37-year-old Japanese female who had been suffering from
posterior uveitis. To avoid proliferative changes, 360°
laser photocoagulation of the
retinal nonperfusion region located in the far periphery was first delivered to the left eye over 2 sessions. Soon
after treatment, the patient complained of acute
photophobia and blurred vision in the treated eye. Ocular examination revealed left pupil dilation and poor
light sensitivity, although the pupil was reactive to a close stimulus. The left pupil also displayed positive
denervation sensitivity based on the dilute
pilocarpine (0.125%) test.
Adie's pupil was diagnosed based on these observations. Three months later, similar, albeit milder, findings were observed in her right eye after 360° peripheral
laser photocoagulation that was more conservatively performed over 4 sessions. Four months after the first treatment, her subjective visual function had improved, and the pupil diameter had decreased to a normal size in both eyes without additional treatment. We encountered a patient whose severity of
Adie's pupil was apparently reduced by more conservative
laser photocoagulation of the ischemic peripheral retina.