A 28-year-old woman has a large, fixed right pupil with vermiform movements of the iris border and sluggish near response. On systemic examination her ankle jerks are absent. The most likely diagnosis is:
- A Argyll Robertson pupil
- B Horner syndrome
- C Holmes-Adie syndrome ✓
- D Early third nerve compression
Correct answer: C. Holmes-Adie syndrome
Explanation
Holmes-Adie syndrome is a tonic pupil, usually unilateral and dilated, with sectoral iris palsies and vermiform movements, combined with absent deep tendon reflexes (Ross variant when accompanied by hyporeflexia). It reflects damage to the ciliary ganglion with aberrant regeneration favouring accommodation fibres. Argyll Robertson pupils are small and bilateral with syphilis, which excludes option A.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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