This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Neuro-Ophthalmology, Subject name: Ophthalmology
In Holmes-Adie pupil all are true except- 
Select and explain. 
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
B: Most cases are bilateral
Answer: B: Most cases are bilateral 
Explanation: 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.