Features:
(1) unilateral at onset with unequal pupils, later becomes bilateral.
(2) affected pupil dilated large, oval and may be irregular early in course, then becomes small
(3) segmented palsy and segmental spontaneous movement of the iris
(4) delayed constriction in response to near vision (slow tonic response that may be exaggerated)
(5) delayed redilation after near vision
(6) impaired accommodation with blurring of near vision
(7) poor or absent constriction to light (light reflex)
(8) absent deep tendon reflexes
(9) supersensitivity to dilute pilocarpine solution (< 0.125%), with constriction
where:
• Tonic refers to delayed or absent papillary movements.
Other associations:
(1) often in otherwise healthy women 20-40 years of age
(2) when a reflex is elicited the iris undergoes vermiform movements which are often segmental
(3) rare patients develop signs of autonomic dysfunction
