William John Adie is best known for his account of the tonic pupil, a physical finding of a dilated pupil that reacts poorly to light but better to accommodation. The reaction of the pupil is sluggish and is usually unilateral, most often seen in women, commonly with absent leg tendon reflexes.^1,2 The pathology is now localised to the ciliary ganglion. The preserved response of the pupil to accommodation results from the higher percentage of fibres from the ciliary ganglion that innervate the iris for accommodation than for constriction to light.

Adie described 19 patients, 13 with absent tendon reflexes, and noted 44 reported cases of tonic pupil. In an exemplary clinical essay, he outlined four incomplete forms (the last would not now be accepted):

1. The complete form—typical tonic pupil and absence of reflexes

2. Incomplete forms: a) tonic pupil alone; b) atypical phase of the tonic pupil …