Electronic Pupillometry Supporting the Diagnosis of Adie’s Tonic Pupil Following Pterygium Surgery

This article reports the case of a 40-year-old man who underwent right primary pterygium surgery, resulting in the successful removal of the pterygium and a good cosmetic outcome. However, one month after surgery, the patient noticed that his right pupil was enlarged. He was referred for a neuro-ophthalmologic examination, and a diagnosis of Holmes-Adie syndrome was made. The pupil abnormality was considered unlikely to be iatrogenic from the surgery. Both of the patient’s pupils demonstrated light-near dissociation due to bilateral Holmes-Adie syndrome, indicating a pre-existing, previously undiagnosed tonic pupil in the left eye. The pupillary findings were confirmed using the handheld NPi-200 electronic pupillometer.