Lesions of the ciliary ganglion as a cause of Argyll Robertson and Adie pupils.

MANY and varied are the lesions postulated for the Argyll Robertson pupil (Duke-Elder, 1949). Cord lesions, and lesions in the afferent pathway, midbrain, and efferent pathway, including the ciliary ganglion and iris, have all been suggested at various times. The difficulty of detecting small changes in nerves and brain at autopsy has probably accounted for this. Adie's pupil, on the other hand, has not excited so much comment, probably because no autopsy material has been forthcoming. The theories about the site of the lesion in cases of Adie pupil range from that of Lowenstein and Friedman (1942), suggesting the diencephalon, to that of Adler and Scheie (1940), suggesting the ciliary ganglion. A case of Adie pupil following herpes zoster ophthalmicus is described below, and an attempt will be made to show that both the Adie and Argyll Robertson pupils have their origins in a ciliary ganglion lesion.