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Vision Information - Holmes-Adie Syndrome

Vision Information - Holmes-Adie Syndrome

Holmes-Adie syndrome is a neurological disorder that affects the pupil of the eye and the autonomic nervous system.

Characteristic symptoms are a larger than normal pupil in one eye that constricts slowly in bright light and the absence of deep tendon reflexes, usually occurring in the Achilles tendon.

The cause of Holmes-Adie syndrome is thought to be a viral or bacterial infection which inflames and damages neurons in the ciliary ganglion (the area in the brain controlling eye movement), and the spinal ganglion (the area in the brain involved in the response of the autonomic nervous system.

The disease starts gradually in one eye and often progresses to the other. Initially, the loss of deep tendon reflexes may be felt only on one side of the body, but then it progresses to the other side. The eye and reflex symptoms do not necessarily appear at the same time.

The disorder may cause excessive sweating, sometimes only on one side of the body.

The symptomatic combination of abnormal pupil size, loss of deep tendon reflexes, and excessive sweating usually is called Ross's syndrome although some doctors may still diagnose the condition as an offshoot of Holmes-Adie syndrome. The HAS symptoms can appear alone or in association with other nervous system diseases, such as Sjogren's syndrome or migraine. Mostly it appears in young women and is rarely an inherited condition.

How is HAS treated?

Ophthalmologists may prescribe glasses to correct vision in the affected eye and daily application of prescribed drops for the constricting dilated pupil. For the excessive sweating, a thoracic sympathectomy (severing of the particular sympathetic nerve) is the typical treatment.


HAS is not a life-threatening or disabling disorder, although the loss of deep tendon reflexes is permanent. Some symptoms of the disorder can progress but prescribed drops and eyeglasses will, in most cases, improve vision.

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