ADIES TONIC PUPIL

Tonic Pupil People

In this section, the speaker discusses tonic pupil people and how to differentiate them from other common causes of people dysfunction.

Key Features of Tonic Pupil People

• Increased tone on the mir response is a key feature of tonic pupil people.

• Unilateral or bilateral sector paresis is another important feature to look for in tonic pupil people.

• A warm, vermiform movement in the pupil can also be observed in patients with sector paresis and tonic reaction of pupils.

• Other motility deficits such as ptosis should not be present in patients with tonic pupil people.

Diagnosis and Confirmation

• To diagnose tonic pupil people, it is important to rule out third nerve palsy by looking for sector paresis.

• Nightmare dissociation that is tonic confirms the diagnosis of tonic pupil people clinically.

• Low-dose pilocarpine can be used to confirm the diagnosis by constricting the pupils. However, this test should not be used alone to make a diagnosis.

Mimickers and Evaluation

• Bilateral cases of tonic pupil people should be evaluated for Lightner dissociation on a central basis as they may mimic other conditions such as Argyll Robertson pupils or dorsal midbrain syndrome from impression and syphilis.

• Syphilis serology tests are recommended for all patients with bilateral simultaneous symptoms. Imaging studies may also be necessary.