Bilateral Tonic Pupils In the Absence of Pupillary Cholinergic Supersensitivity

摘要

Goktas and Goktas describe an intriguing case of a young woman with assumed bilateral tonic pupils in the absence of pupillary choiinergic supersensitivity. In the article, the lack of choiinergic supersensitivity is explained by reinnervation of the iris sphincter.A tonic pupil occurs because of postganglionic parasympathetic denervation of the iris sphincter. The denervated segments show choiinergic supersensitivity to pilocarpine. Aberrant regeneration of accommodative fibres into the iris sphincter, called the reinnervation process, follows segmental denervation. Once the sphincter segments become reinner-vated more completely by the accommodative fibres, the response to the choiinergic supersensitivity may diminish or resolve completely. Therefore, the degree of parasympathetic degeneration and regeneration of the efferent pupillomotor fibres influences the degrees of choiinergic supersensitivity and light-near dissociation.