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LESIONS OF THE CILIARY GANGLION AS A CAUSE OF ARGYLL ROBERTSON AND ADIE PUPILS

1959; BMJ; Volume: 43; Issue: 8 Linguagem: Inglês

10.1136/bjo.43.8.471

1468-2079

Mary Cameron,

MANY and varied are the lesions postulated for the Argyll Robertson pupil (Duke-Elder, 1949).Cord lesions, and lesions in the afferent pathway, mid- brain, and efferent pathway, including the ciliary ganglion and iris, have all been suggested at various times.The difficulty of detecting small changes in nerves and brain at autopsy has probably accounted for this.Adie's pupil, on the other hand, has not excited so much comment, probably because no autopsy material has been forthcoming.The theories about the site of the lesion in cases of Adie pupil range from that of Lowen- stein and Friedman (1942), suggesting the diencephalon, to that of Adler and Scheie (1940), suggesting the ciliary ganglion.A case of Adie pupil following herpes zoster ophthalmicus is described below, and an attempt will be made to show that both the Adie and Argyll Robertson pupils have their origins in a ciliary ganglion lesion. Case ReportA married woman aged 26 years, was first seen on May 6, 1956, with a very severe right herpes zoster ophthalmicus of 3 days' duration.There was marked vesiculation over the path of the right supra-and infratrochlear and supra-orbital nerves.The lids were grossly swollen and overriding each other and there was marked chemosis of the con- junctiva, with staining by fluorescein of a small horizontal patch in the centre of the cornea.The pupil was three-quarters dilated, because of previous treatment with atropine drops, the dilation being greater on the temporal side.The right fundus was normal.There was no impairment then or subsequently of the ocular motility, but a loss of corneal sensation was noted.Treatment was begun with atropine drops, cortisone drops, and chloramphenicol ointment.On June 18, 1956 (6 weeks after the onset and while atropine was still being used), the right eye was white, with clear cornea and normal fundus.The right visual acuity (under atropine) was 6/5 with correction -15 D sph., +0 5 D cyl., axis 600.The atropine was stopped.6 weeks after stopping the atropine and 3 months after the onset, the right pupil was still irregularly dilated and did not react to light directly or consensually, or to accommoda- tion.On March 12, 1957, 10 months after the onset of the herpes zoster, the patient reported that the right pupil, which had previously been immobile, was now changing its size.She had noticed this for the first time only a few days before when she looked into her mirror.Examination.-Theright pupil was irregularly dilated, with its long axis from 10 to 5 o'clock.It measured about 6 x 5 mm.and did not react to light directly *