Indian Journal of Ophthalmology - Case Reports

: 2022  |  Volume : 2  |  Issue : 3  |  Page : 736--738

Intervention of Adie's tonic pupil with iris tinted contact lenses with clear pupil - Case report

Hiral J Korani1, Karishma Bhate2, Disha Bhalakia3,  
1 Department of Optometry, Lotus College of Optometry, Mumbai, Maharashtra, India
2 Department of Glaucoma, Lotus Eye Hospital, Mumbai, Maharashtra, India
3 School of Optometry, Bharati Vidyapeeth Deemed University, Pune, Maharashtra, India

Correspondence Address:
Dr. Hiral J Korani
Lotus College of Optometry, 13th NS Road, Vithalnagar Society, JVPD, Juhu - 400 049 Mumbai, Maharashtra


We report the optometric management of a 27-year-old female diagnosed with Adie's tonic pupil who was otherwise systemically stable. This case report is an effort to understand how tonic pupil management with iris tinted clear pupil contact lenses helps to resolve quantitative and qualitative visual disturbances similar to pharmacological treatment (diluted pilocarpine). The case report shows that it is an effective alternative management to overcome visual symptoms for patients with Adie's tonic pupil compared to pilocarpine (0.1%).

How to cite this article:
Korani HJ, Bhate K, Bhalakia D. Intervention of Adie's tonic pupil with iris tinted contact lenses with clear pupil - Case report.Indian J Ophthalmol Case Rep 2022;2:736-738

How to cite this URL:
Korani HJ, Bhate K, Bhalakia D. Intervention of Adie's tonic pupil with iris tinted contact lenses with clear pupil - Case report. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2023 Feb 7 ];2:736-738
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Full Text

Adie tonic pupil is a neurological disorder in which there is parasympathetic denervation of the affected pupil, leading to dilated unilateral or bilateral pupils with light-near dissociation, photophobia, and blurry near vision.[1],[2] It is common in females between 20 and 40 years of age.[1] The low-concentration pilocarpine (0.01%) test helps to demonstrate the cholinergic denervation in the affected eye.[1],[2]

Management for Adie's tonic pupil includes prescription of bifocal spectacles or low-dose pilocarpine. Long-term use of pilocarpine can lead to ciliary spasm, brow ache, worsen anisocoria, or induce nearsightedness.[3] Use of tinted contact lenses with clear pupils has proven beneficial in conditions such as albinism to reduce photosensitivity.[4],[5] Use of contact lenses has been limited in the management of Adie's tonic pupil. This case report describes the management of a patient with Adie's tonic pupil with poor visual function by using an iris-tinted contact lens with a 4-mm clear pupil and compared with diluted pilocarpine administration.

 Case Report

A 27-year-old female presented to Lotus Eye Hospital for a second opinion on June 17, 2021 with complaints of irregular pupil size in the last 2–3 months and photophobia. She was prescribed pilocar 2% in the left eye twice a day (for 1 week) elsewhere but did not use it. The patient had no history of ocular surgery, trauma, or any systemic disease in the past. Her best-corrected visual acuity in each eye was 0.0 logMAR for distance and 0.4 M for near at 40 cm. Her extraocular motility was normal. The anterior segment examination revealed anisocoria, with the left eye (affected eye) pupil being larger (7 mm) and not responsive to direct and indirect light stimulus as compared to the right eye [Figure 1] and poor response to near reflex. No abnormality was detected in the posterior segment.{Figure 1}

Pharmacological testing was undertaken by instilling diluted pilocarpine (0.1%) in both eyes. After 30 min, the pupils were observed showing left eye pupil constriction, while the right eye pupil remained unaffected confirming the diagnosis of Adie's tonic pupil [Figure 2].{Figure 2}

Our patient had Adie's pupil without any systemic autonomic involvement. She did not have any clinical findings to support predisposing systemic illness and was evaluated by a neurologist to rule out other potentially serious disorders.

She was referred to the contact lens department of Lotus College of Optometry for qualitative and quantitative tests comparison, such as contrast sensitivity with glare tester, distance and near visual acuity, and amplitude of accommodation between iris tinted with clear-pupil contact lens and pilocarpine versus without intervention. She visited on June 18, 2021, prior to the contact lens fitting and pilocarpine instillation. Written consent was obtained for identifiable health information included in this case report, and authorization for a waiver from the ethics committee of Lotus College of Optometry and Lotus Eye hospital was approved. All the tests were measured at baseline with distance spectacles, carried out by a final year optometry student under the supervision of a senior optometrist. She was fitted with lenses (Purecon Pvt. Ltd.) in her left eye having median base curve, 14-mm diameter, 4-mm clear pupil diameter, Plano power, and dark brown “C” type iris color [Figure 3]. Measurements were repeated post 30 min of obtaining the optimal fitting. Similarly, tests were repeated post 30 min of 2% pilocarpine diluted to 1/10th. No difference was found in the visual functions such as near vision and amplitude of accommodation under three conditions (distance spectacles, with contact lens, and diluted pilocarpine). Contrast sensitivity with glare source was found to be better with contact lens than the other two conditions [Table 1].{Table 1}{Figure 3}


Two major goals achieved in this patient with the use of contact lenses included (1) a decrease in glare and (2) cosmetic improvement of anisocoric pupils.

The use of tinted soft lenses for aniridia, albinism, and Adie's tonic pupil has been reported in the literature.[5],[6],[7] Studies have shown that the use of tinted soft contact lenses/spectacles decrease photophobia in various types of patients.[7],[8] The present case report demonstrates that the use of a tinted-iris contact lens with a 4-mm clear pupil reduces glare sensitivity and delivers an advantage on the visual function. Philips et al.[9] observed that when a severe albino patient was fitted with a soft prosthetic contact lens, photophobic symptoms reduced and facial cosmesis was enhanced. Studies on reduced pupil diameter and accommodation have reported no induced accommodative effect,[10] which was also noted in this case study.

Studies have reported pilocarpine eye drops being successful and the most acceptable treatment for Adie's tonic pupil. However, 1%–4% pilocarpine is poorly tolerated due to significant ocular side effects.[5] Dilute formulation of pilocarpine 0.1% is considered, but this formulation is not commercially available and has to be specially compounded, which may be expensive; moreover, its sterility is questionable. Though the patient's functional vision with pilocarpine and contact lens was the same, because of expense and sterility issues, contact lens was considered to be an ideal management plan.

Therefore, clinicians encountering a symptomatic patient with Adie's pupil should prescribe/consider iris-tinted clear-pupil contact lens to overcome the symptoms of photophobia and cosmesis.


Contact lenses with tinted iris and clear pupil can be prescribed to patients with Adie's tonic pupil for reducing the amount of light entering the dilated pupil, thereby decreasing the symptoms of glare and sensitivity to light and not affecting accommodation. However, appropriate care and maintenance are needed to fulfill the rehabilitative role in patients with Adie's tonic pupil.

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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