CET and skills guides

Study and gain CET points through OT’s online CET exams, and access archived CET, CPD articles and skills guides in our education library

Find out more

Science and vision

News and features about the latest scientific developments and advances in optometry, ophthalmology and eye medicine

Find out more

Professional support

News and features about the latest developments relating to professional support from across optics. This includes updates from optical organisations such as the AOP and the GOC

Find out more

In practice

News and in-depth features about business management and career development in optics

Find out more


Explore the latest UK and global jobs in the optical sector for optometrists, dispensing opticians and more

Find out more

Unravelling the mystery of an unreactive pupil

A 40-year-old Canadian patient presented to hospital following four months of photophobia, blurred vision and a dilated right pupil

brown eye and pupil
BMJ Case Reports authors have described their treatment of an otherwise healthy 40-year-old whose pupil was unreactive to light.  

On presentation to hospital, the patient described a four-month history of photophobia in his right eye and mildly blurred vision, which was exacerbated at near distances.

The patient had normal visual function but his right pupil was larger, with the difference becoming more marked in brighter lighting conditions.

Clinicians presented a diagnosis of Adie’s tonic pupil after a detailed examination did not reveal any underlying secondary cause.

The patient’s symptoms quickly resolved following treatment with pilocarpine 0.1%.

The authors highlighted that a tonic pupil refers to one that has poor or no reaction to light.

It is thought to be caused by damage to the short ciliary nerves or the ciliary ganglion and can be caused by infection or trauma.

“When a tonic pupil is idiopathic, it is termed Adie’s tonic pupil, and when it is associated with deep tendon reflexes it is termed Adie's syndrome,” the authors explained.

Image credit: Pixabay/Juraj Varga