In Holmes-Adie pupil all are true except-: (A) There is absent or retarded pupil reaction to light and near, (B) Most cases are bilateral, (C) Causes reduced or absent accommodation, (D) Constricts with 2.5% methacholine
Answer is B. Ans. (b) Most cases are bilateralRef: Kanski 7/e, p. 815Typically affects young adults and presents as unilateral condition in 80% casesDLR and CLR are absentNear reflex is blow (sluggish)As there is defect in post-ganglionic para-sympathetic innervation to eye, i.e., there is deficiency of parasympatholytic system, the pupil will react when even a minimum concentration of parasympathomimetic drugs (e.g. 0.125% pilocarpine, 2.5% methcholine) is given.