Abstract
We have compared the diagnostic ability of different concentrations of 0.125% and 0.0625% dilute pilocarpine for detecting denervation supersensitivity in unilateral Adie’s tonic pupil. This retrospective, observational, case–control study involved 117 subjects, consisting of 56 patients with unilateral Adie’s tonic pupil and 61 controls with other causes of unilateral dilated pupils. Subjects underwent the dilute pilocarpine test with one of the two concentrations, 0.125% or 0.0625%. Pupillary light reflex was recorded with a dynamic pupillometer at baseline and at 30–40 min after instilling one of the two concentrations of dilute pilocarpine. Diagnostic accuracy of two different concentrations of the dilute pilocarpine test, 0.125% group versus 0.0625% group, were compared by area under the receiver operating characteristic curve (AUC). Diagnostic ability of the dilute pilocarpine test for detecting denervation supersensitivity in unilateral Adie’s tonic pupil was significantly better in the 0.0625% group than in the 0.125% group (AUC = 0.954 vs. 0.840, respectively, P = 0.047). In the 0.0625% group, the change in maximal pupil diameter of ≥ 0.5 mm after topical pilocarpine instillation showed 100% sensitivity and 82.8% specificity for detecting Adie’s tonic pupil. This study confirmed that pupillary constriction with 0.0625% pilocarpine is better than 0.125% pilocarpine for detecting denervation supersensitivity in Adie’s tonic pupil. Digital pupillometry is a reliable method for assessing denervation supersensitivity in Adie's tonic pupil.
Highlights
We have compared the diagnostic ability of different concentrations of 0.125% and 0.0625% dilute pilocarpine for detecting denervation supersensitivity in unilateral Adie’s tonic pupil
In particular, changes in anisocoria, after administration of dilute pilocarpine in unilateral Adie’s tonic pupil can be quantified by digital pupillometry, which can help clinicians distinguish it from other types of physiological and pathological anisocoria
We compared the diagnostic ability of the two concentrations of pilocarpine, 0.125% versus 0.0625%, for detecting denervation supersensitivity in unilateral Adie’s tonic pupil among other causes of unilateral dilated pupils
Summary
We have compared the diagnostic ability of different concentrations of 0.125% and 0.0625% dilute pilocarpine for detecting denervation supersensitivity in unilateral Adie’s tonic pupil. Adie’s tonic pupil is caused by damage to the postganglionic parasympathetic nerve of the iris sphincter muscle It is characterized by loss of direct and indirect pupillary light reflexes, accommodative paresis, segmental palsy of the iris, and denervation supersensitivity[1,3,4,5]. False positive responses to dilute pilocarpine are not uncommon, where Younge and Buski[9] found significant constriction in 15% of the normal pupils after instillation of 0.1% pilocarpine To overcome this limitation, 0.0625% pilocarpine instillation was suggested as an alternative test to detect denervation supersensitivity in Adie’s tonic pupil[10]. We compared the diagnostic ability of the two concentrations of pilocarpine, 0.125% versus 0.0625%, for detecting denervation supersensitivity in unilateral Adie’s tonic pupil among other causes of unilateral dilated pupils
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