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Year : 2022  |  Volume : 17  |  Issue : 1  |  Page : 87-88

Adie’s pupil after chickenpox infection

1 Department of Ophthalmology, Royal Glamorgan Hospital, Ynysmaerdy, United Kingdom
2 Department of Paediatrics, Royal Glamorgan Hospital, Ynysmaerdy, United Kingdom

Date of Submission21-Aug-2020
Date of Decision03-Oct-2020
Date of Acceptance21-Oct-2020
Date of Web Publication12-Jul-2021

Correspondence Address:
Dr. Derek Kwun-hong Ho
Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant CF72 8XR
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpn.JPN_214_20

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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

How to cite this article:
Ho DK, Ranjan R, Goyal R. Adie’s pupil after chickenpox infection. J Pediatr Neurosci 2022;17:87-8

How to cite this URL:
Ho DK, Ranjan R, Goyal R. Adie’s pupil after chickenpox infection. J Pediatr Neurosci [serial online] 2022 [cited 2023 Dec 8];17:87-8. Available from: https://www.pediatricneurosciences.com/text.asp?2022/17/1/87/321162

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.
Figure 1: Anisocoria with right dilated and fixed pupil

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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.[1] 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.[2] Internal ophthalmoplegia, or Adie’s pupil, appears to be extremely rare and has also been described as a complication following primary chickenpox infection.[3],[4] The clinician must be aware of other differential diagnoses for enlarged pupil, including oculomotor nerve palsy.

Authors’ contribution

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.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Tappeiner C, Aebi C, Garweg JG Retinitis and optic neuritis in a child with chickenpox: case report and review of literature. Pediatr Infect Dis J 2010;29:1150-2.  Back to cited text no. 1
Sungur G, Hazirolan D, Duran S, Satana B, Arikan I, Duman S The effect of clinical severity and eyelid rash on ocular involvement in primary varicella infection. Eur J Ophthalmol 2009;19:905-8.  Back to cited text no. 2
Heger T, Kolling GH, Dithmar S Atypical tonic pupil as a complication of chickenpox infection. Ophthalmologe 2003;100:330-3.  Back to cited text no. 3
Orssaud C, Roche O, El Dirani H, Dufier JL Delayed internal ophthalmoplegia and amblyopia following chickenpox. Eur J Pediatr 2006;165:728-9.  Back to cited text no. 4


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