Currently, neurological diseases are gaining high prevalence. This is due to poor ecology, heredity, a large number of different infections and so on. Among such defects is Adie’s syndrome (Holmes-Adi), which is most often observed in people with damage to the postganglionic fibers of the eye, which occurs due to a bacterial infection. In this case, the eye pupil partially or completely loses its ability to narrow. It acquires an oval shape or becomes uneven, there is a segmental lesion of the iris.
Description
Holmes-Adie Syndrome is a neurological disorder that is characterized by constant dilatation of the pupil, the response to light of which is very slow, but a pronounced reaction is observed with bright close dissociation. Thus, the pupil, when approaching, narrows fairly slowly or does not narrow at all, and returns even more slowly to its original size, sometimes within three minutes. With a prolonged stay in the dark, the patient has an expansion of the pupil. Adi syndrome in neurology is associated with the fact that a bacterial infection contributes to damage to neurons in the accumulation of nerve cells that are located in that part of the orbit that is located behind and control eye contraction. In addition, in people with such a disease, a violation of the autonomic control of the body is observed, which is associated with damage to nerve cells in the spinal cord. The ankle is supported in a person, sweating is impaired. The disease happens:
- Congenital, which is characterized by dysfunction of the Achilles reflex, visual impairment when viewed from an object close is not observed.
- Acquired, which is caused by visual impairment at close examination, which is corrected by instillation of myotic agents. It occurs after injuries, infections and poisoning.
Etiology and epidemiology
Adie's syndrome has not been fully studied to date, in some cases it is customary to consider it a symptom at the stage of development of autonomic failure. Most often, the disease occurs in the fairer sex at the age of about thirty-two years. Cases of familial disease are known. National and racial attributes do not play any role.
In most cases, the disease manifests itself unilaterally with mydriasis. This ailment is quite rare, in some sources one case of pathology is indicated for twenty thousand people. These are most often single cases, but sometimes anomaly can be observed in entire families. Children rarely get this disease. A large number of patients seek help from the age of twenty to fifty years. The origin of the syndrome is unknown, it appears in people who do not have any eye pathologies. In rare cases, the disease occurs with injuries of the orbit, and also as a result of metastasis of cancerous tumors into the orbit of the eye.
Causes
Adie Syndrome causes unclear at present. It is only known that the ciliary node that is located in the orbit is affected, this provokes an anomaly in the work of the muscles responsible for the ability to clearly see objects at a distant distance. The ability to see sometimes returns, but the pupil does not respond to light. The main reasons for this pathology are considered by doctors:
vitamin deficiency and infectious diseases;
congenital myotinia;
cold sore eyes;
atrophy of the eye muscles, which is progressing;
inflammation of the brain or its membranes.
Symptoms
Symptoms of the disease are three criteria:
- Pathologically dilated one pupil that does not respond to light.
- Loss of tendon reflexes
- Sweating Disorder.
Other symptoms with such an ailment as Adie’s syndrome can manifest in photophobia, farsightedness, decreased vision, headache, and decreased foot reflexes. Pupil size may vary throughout the day. First, one eye is affected, but after a few years, the second eye may also be affected.
The disease manifests itself immediately after a severe headache attack, then mydriasis begins to develop, vision deteriorates, blurring occurs when examining objects that are closely located. In most cases, there is a loss of tendon reflexes, hyperthermia.
Adie Syndrome: Diagnosis
Diagnosis is possible using a slit lamp. A test is also carried out using Pilocarpine, a solution of which is instilled into the eyes and the pupils are observed for the next twenty-five minutes. In this case, a healthy eye does not show any reaction, the pupil narrows on the affected eye. Often a study is conducted on MRI and CT. Ciliary nerves can become inflamed in the presence of diphtheria, especially in the third week of the course of the disease. Then the pupils are restored. Adie's syndrome is very similar to A. Robertson's syndrome, which is characteristic of neurosyphilis, therefore, diagnostic measures are carried out to make an accurate diagnosis.
If there is a pupil pathology, and the reasons are unknown, they are examined using a slit lamp to exclude mechanical injuries of the iris, the presence of a foreign body, injury, the inflammatory process, as well as adhesions, glaucoma.
Treatment
Usually, with a disease such as Adie’s syndrome, treatment is not developed. Therapy does not have the desired effect. Patients are credited with points that correct violations. Drops of “Pilocarpine” are also prescribed to correct an eye defect. Sweating disorders are treated using breast sympathectomy. This disease is not completely cured.
Forecast and Prevention
All pathological changes in a disease such as Adie’s syndrome are irreversible, so the prognosis is somewhat unfavorable. But the disease does not pose a danger to life and does not affect a person's ability to work. But in some cases, the disappearance of tendon reflexes may develop even more over time. Then both pupils are amazed, acquire a small size and practically do not respond to light. Treatment with drops of "Pilocarpine" does not bring obvious results.
Preventive measures are aimed at the timely treatment of infectious diseases, which often give complications. You must eat right and observe the daily routine. A healthy lifestyle helps to reduce the risk of developing various pathological conditions in the human body.
Thus, this disease is incurable, it is only possible to reduce the manifestation of symptoms, over time, the disease can progress and lead to bilateral eye abnormalities. But the disease is not life threatening, since no deaths were observed with this disease.