Holmes-Adie syndrome associated with BNT162b2 mRNA COVID-19 vaccine

Abstract

Adie’s tonic pupil is a neuro-ophthalmologic disorder with dilation and poor light response. When deep tendon reflex loss accompanies the tonic pupil, it is called Adie syndrome or Holmes-Adie syndrome. The pupillary symptoms result from damage to the ciliary ganglion and the post-ganglionic parasympathetic nerves. Corona virus 2, which causes severe acute respiratory syndrome, has been named corona virus 19 (COVID-19) by the World Health Organization. It has been reported that the coronavirus infection has neurological manifestations including pupillary involvement.[1,2] The cases of two patients with Adie’s tonic pupil 10–15 days after they had BNT16b2b mRNA (Pfizer, BioNTech, Germany) vaccine were reported. One of them had Holmes-Adie syndrome.[3,4] In this case report, we aim to describe two patients who are a married couple with possible coronavirus BNT16b2b mRNA vaccine (Pfizer, BioNTech, Germany)-related Holmes-Adie syndrome.