What treatment is recommended for Adie tonic pupil?

• A. 0.125% Pilocarpine bid-qid
• B. Atropine eye drops
• C. Laser therapy
• D. Antibiotic drops

Answer: (A)

Adie tonic pupil occurs when the parasympathetic fibers to the iris sphincter are damaged, leaving a dilated pupil with poor light response but often preserved accommodation. The interesting feature is denervation leads to supersensitivity of the sphincter muscle to cholinergic stimulation. Because of this, a very dilute pilocarpine solution can constrict the affected pupil while a normal pupil remains mostly unchanged. Using dilute pilocarpine serves both diagnostic and therapeutic purposes: it constricts the Adie pupil, helps reduce photophobia and anisocoria, and confirms the diagnosis by showing selective constriction. A commonly used regimen is a dilute concentration such as 0.125% pilocarpine several times daily (bi- to qid), adjusted by response. In contrast, atropine would widen the pupil and worsen symptoms, laser therapy has no role in neurogenic Adie, and antibiotics are not relevant to this condition.