The Indication of MRT or CT and Serological Diagnostic in Patients with Tonic Pupil
Schnitzler E., Gusek-Schneider G.-C.
Department of Ophthalmology and Eye Hospital, University Erlangen-Nuremberg, Erlangen
Purpose: Tonic pupil is a common disease of the parasympathic innervation. It may be caused by several diseases. There are different opinions about the necessary diagnostic tools.
Method: The clinical history of 34 patients (23 female,11 male) was investigated retrospectively. All patients underwent ophthalmological, orthoptic and neurological investigation and MRT (31 patients) or CT (3 patients). If there was no positive result of these investigations and manifestation of the tonic pupil was not older than five years, a serologic investigation was performed. The serologic investigation included tests of an infection caused by Herpes virus, Ebstein Barr virus, Toxoplasma gondii and Treponema pallidum.
Results: MRT or CT did not show any reason of the tonic pupil in this study. The neurological investigation showed the diagnosis of an Holmes-Adie syndrome in six cases, the diagnosis of an Ross syndrome in one case and the diagnosis of an Parry-Romberg syndrome in another case. The serologic diagnostic of Herpes simplex virus showed in four patients positive level of IgM antibodies and in one patient a borderline positive level of IgM antibodies. One of this patients underwent specific antiviral therapy. There was no change of the symptoms of tonic pupil under this therapy. The IgM of varicella zoster virus was positive in one patient. The serologic diagnostic
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