How is pharmacological testing for Adie's tonic pupil conducted?

Pharmacological testing for Adie's tonic pupil is primarily conducted by instilling a low concentration of pilocarpine, typically 0.125%, in the affected eye. This test assesses the pupil's response to cholinergic stimulation. In Adie’s pupil, there is a reduced response to light and accommodation due to impaired parasympathetic function. However, the affected pupil often demonstrates a hypersensitivity to pilocarpine when tested with this diluted concentration.

When pilocarpine is applied, a normal pupil will constrict minimally since it already has adequate cholinergic activity, but the affected pupil will constrict significantly due to its abnormal sensitivity to pilocarpine's action. This contrast helps to differentiate Adie's pupil from other types of pupil abnormalities.

Using 1% pilocarpine in both eyes or instilling systemic atropine would not provide the specific response needed for this diagnosis and would likely confound the results. Measuring intraocular pressure after medication does not directly assess pupillary function and is not relevant to this particular test for Adie's tonic pupil. Thus, the administration of 0.125% pilocarpine in the affected eye is the standard method used to identify this form of pupils' dysfunction.