<prompt> In Holmes-Adie pupil all are true except-There is absent or retarded pupil reaction to light and nearMost cases are bilateralCauses reduced or absent accommodationConstricts with 2.5 methacholine  <response>: Ans. b Most cases are bilateralRef: Kanski 7e, p. 815Typically affects young adults and presents as unilateral condition in 80 casesDLR and CLR are absentNear reflex is blow sluggishAs there is defect in post-ganglionic para-sympathetic innervation to eye, i.e., there is deficiency of parasympatholytic system, the pupil will react when even a minimum concentration of parasympathomimetic drugs e.g. 0.125 pilocarpine, 2.5 methcholine is given. 