Acute Adie syndrome

Parasympathetic denervation of the iris sphincter muscle in Adie syndrome results in an enlarged tonic right pupil reacting poorly to light (A, B). Near response was also impaired (C). It is supersensitive to cholinergic agents (pilocarpine 0.1%) (D). Paralysis of the iris results in characteristic segmental vermiform movements. These are visible superolaterally acutely and inferomedially 6 months later