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🎧FREE MSRA PODCAST –Holmes-Adie Pupil: Lazy Light, Active Close 👁️
In this high-yieldDeep Dive episode, we unravel Holmes-Adie Pupil(aka Adie’s Tonic Pupil) — a fascinatingneuro-ophthalmological condition every MSRA candidate should know. We break itdown from definition to diagnosis, using clear memory tips like “lazy to light, active to close” to help yourecall it on exam day.

🧠What You'll Learn inThis Episode:
✅Definition &Overview
• A neurological condition affecting the pupil's response to light and accommodation
• Pupils are dilated, react poorlyto light, but better to near focus
• Often unilateral, more common in younger women (20–40)

🔍Mnemonic for MSRARevision:
Lazy to Light, Active to Close
→ Light reflex =slow
→ Accommodationreflex = preserved

⚙️Pathophysiology MadeSimple
• Caused by damage to parasympathetic fibres from the ciliary ganglion
• Often idiopathic or post-viral(e.g., herpes zoster)
• Leads to denervation of iris sphincter → impairedconstriction to light

🩺Clinical Features
• Unilateral dilated pupil (in ~80% of cases)
• Minimal/slow reaction to light
• Better near response (accommodation)
• Vermiform movements of the iris may be seen
• May cause blurred vision, especially for close work
• Associated with Holmes-Adie syndrome: tonic pupil + reduced reflexes (esp. ankle and knee)

🧪DifferentialDiagnoses to Remember
• Pharmacological dilation (e.g., mydriaticdrops)
• Third nerve palsy (includes ptosis, eyemovement issues)
• Horner’s syndrome (miosis + ptosis +anhidrosis)
🧠 Think: Is the pupil dilated or small?Any other cranialnerve signs? Always examinethoroughly.

🧪How to Confirm ItClinically
• Key test: Dilute pilocarpine 0.1%
→ In Holmes-Adie:hypersensitive denervated pupil will constrict
→ Normal pupil orpharmacologically dilated one won’t react
• Also: slit lamp exam, tonometry,and possibly imaging if red flags present

🩻Management &Treatment
• No cure, but often benign and self-limiting
• Reassurance + reading glasses for accommodationissues
• Pilocarpine drops may help for near tasks inselect cases
• Refer infants 1 year to paediatric neurology
• Educate patientson the benign nature + need for regular eye checks

📊Prognosis
• Excellent – doesn’t progress or cause serious damage
• Some pupils mayshrink over time (may even become smaller than normal pupil)
• Accommodation mayimprove slowly
• Rare association:slightly increased cataract risk

📚Holmes-Adie PupilResources for the MSRA
📝 Revision Notes:
https://www.passthemsra.com/topic/holmes-a... (https://www.passthemsra.com/topic/holmes-a...)
🧠 Flashcards:
https://www.passthemsra.com/topic/holmes-a... (https://www.passthemsra.com/topic/holmes-a...)
📖 Accordion Q&A Notes:
https://www.passthemsra.com/topic/holmes-a... (https://www.passthemsra.com/topic/holmes-a...)
🎯 Rapid Quiz:
https://www.passthemsra.com/topic/holmes-a... (https://www.passthemsra.com/topic/holmes-a...)
🎓 MSRA Practice Questions:
https://www.passthemsra.com/quizzes/holmes... (https://www.passthemsra.com/quizzes/holmes...)

📎 More MSRA resources to accompany this episode:
🌐https://www.passthemsra.com (https://www.passthemsra.com)
🎁https://www.freemsra.com (https://www.freemsra.com)

Hashtags
#MSRA#HolmesAdiePupil #AdiesTonicPupil #Neurology #Ophthalmology #MSRARevision#MSRAFlashcards #MSRAQuiz #MSRAAccordions #FreeMSRA #PassTheMSRA#LazyLightActiveClose #MSRAOphthal #MSRANeurology

Episode link: https://play.headliner.app/episode/2723476...