ADIE´S PUPIL AND MIGRAINE: AN OVERLOOKED ASSOCIATION?

Abstract

Introduction: Adie´s pupil is a neuro-ophthalmological disorder caused by injury of postganglionic parasympathetic nerve fibers of the eye and is defined as a dilated pupil, which is unresponsive to light and moderately responsive to accommodation. Although the etiology remains unknown, there are few reports of Adie´s pupil associated with migraine.

Methods: A 48-year-old woman presented with right pupil dilatation during a migraine attack. The pupillary asymetry persisted after the headache had subsided.

Results: Ophthalmological examination and pilocarpine test results were consistent with Adie`s pupil. Work-up including neuroimaging showed no abnormalities.

Reexamination 3 months later showed persistent unilateral mydriasis.

Conclusions: The chronology of events and the exclusion of other possible etiologies favored the association between Adie´s pupil and migraine. It is possible that severe or prolonged vasospasm can occur during a migraine attack leading to ischemia of parasympathetic fibers resulting in Adie´s pupil. This condition should be distinguished from benign episodic unilateral mydriasis.