Adie’s pupil

This is a neurologic disorder in which one eye becomes dilated. Most patients have no symptoms or visual complaints, but a friend points out that one of their pupils is now much larger than the other. Also, the pupil does not seem to constrict normally with light. An Adie’s pupil usually occurs from damage to one of the nerve clusters behind the eye (inside the eye socket) that controls pupil constriction. This damage can occur from an otherwise harmless viral infection such as a common cold. The problem is usually temporary and goes away after a few months. The opposite condition is called Horner’s syndrome. Horner’s causes pupil constriction and is potentially dangerous.

Dr. Timothy Root is a practicing ophthalmologist and cataract surgeon in Daytona Beach, Florida. His books, video lectures, and training resources can be found at:


  1. An Adie’s pupil is when the parasympathetic nerves to the eye become damaged. Remember:

    sympathetic = fight or flight reflex
    (pupil dilates so you can see in the dark and run away)

    parasympathetic = rest and digest
    (pupil constricts to help you see close-up food)

    With Adies, the “parasympathetic constriction” response is lost. This creates a dilated pupil. My patients may also complain of some difficulty reading up close because of loss of accommodation.

    Adies is generally benign and may get better with time. In fact, the pupil may actually end up SMALLER than it used to be (we call this an “old Adies”).


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