|Ahead of print
Adie’s pupil after chickenpox infection
Derek Kwun-hong Ho1, Rajesh Ranjan2, Raina Goyal1
1 Department of Ophthalmology, Royal Glamorgan Hospital, Ynysmaerdy, United Kingdom
2 Department of Paediatrics, Royal Glamorgan Hospital, Ynysmaerdy, United Kingdom
|Date of Submission||21-Aug-2020|
|Date of Decision||03-Oct-2020|
|Date of Acceptance||21-Oct-2020|
|Date of Web Publication||12-Jul-2021|
Derek Kwun-hong Ho,
Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant CF72 8XR.
Source of Support: None, Conflict of Interest: None
| Abstract|| |
A 2-year-old girl with recent chickenpox infection was noted to have a fixed and dilated right pupil. Diluted 0.1% pilocarpine eyedrop test was successful in constructing the dilated right pupil. Cranial nerve examination and computer tomography brain scan were otherwise normal. We report this case as internal ophthalmoplegia, or post-viral Adie’s pupil, which appears to be extremely rare.
Keywords: Adie’s pupil, chickenpox, internal ophthalmoplegia
A 2-year-old girl with a 7-day history of chickenpox was seen in the eye emergency clinic with bloodshot, photophobic right eye. There has been no lesion on or around her eyelid. On examination, her visual acuity was normal and eye movements were full. There was no sign of herpetic keratitis or anterior uveitis. While her left pupil was reactive to light, the right one was fixed and dilated [Figure 1]. Both fundi were normal and optic discs appeared healthy.
The patient was systemically well and neurological examinations, including cranial nerves, were normal. While accommodation reflex could not be tested due to her age, diluted 0.1% pilocarpine eyedrop test was successful in constricting the dilated right pupil. A computer tomography brain scan was performed, which did not reveal any abnormality. A diagnosis of post-viral Adie’s pupil was made.
Varicella zoster virus of the Herpesviridae family is the causative agent of chickenpox. It also causes herpes zoster ophthalmicus, a relatively common condition seen in the elderly population. Ophthalmic involvement in primary chickenpox infection can include conjunctivitis, corneal lesions, iridocyclitis, chorioretinitis, and optic neuritis. A study of 100 children with chickenpox reported that 8 patients developed conjunctivitis, 12 developed anterior uveitis, and 1 developed disciform keratouveitis. Interestingly, no significant association was found between eyelid rash and ocular involvement. Internal ophthalmoplegia, or Adie’s pupil, appears to be extremely rare and has also been described as a complication following primary chickenpox infection., The clinician must be aware of other differential diagnoses for enlarged pupil, including oculomotor nerve palsy.
DKHH contributed to case identification, initial drafting of manuscript, critical revision of content, and final approval of manuscript. RR and RG contributed to case identification, critical revision of content, and final approval of manuscript. All authors are accountable for all aspects of the work in ensuring that questions related to the patient’s case have been appropriately investigated and resolved.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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