46. Adie's, Amsler, and Rubella Gems

Anatomy: Ciliary ganglion. Pathology: Ciliary ganglion lesion. Disease/Diagnosis: 1. Adie's tonic pupil, 2. Checking central 10 degrees with Amsler grid, 3. Congenital or acquired colored blindness detected by color plate testing, 4. Horizontal or vertical phoria detected by Maddox wing test. Clinical: 1. Adie's tonic pupil: Typically slow or tonic reaction, to almost no reaction, to light in a typically larger unilateral dilated pupil, slow tonic re-dilation from near to distance, pupil dilates well to drops and constricts to weak miotics due to cholinergic hypersensitivity, Patient may have hyporeflexia in the lower extremities; Condition is permanent, vermiform slight reaction in the upper or lower nasal quadrant of the iris on slit lamp exam of the involved pupil may be seen. 2. Accommodation is variably involved.