<prompt> In Holmes-Adie pupil all are true except -There is absent or retarded pupil reactions to light and nearMost cases are bilateralCauses reduced or absent accommodationConstricts with 2.5 methacholine  <response>: The Adies tonic pupil. In this condition reaction to light is absent and to near reflex is very slow and tonic. The affected pupil is larger anisocoria. Its exact cause is not known. It is usually unilateral, associated with absent knee jerk and occurs more often in young women. Adies pupil constricts with weak pilocarpine 0.125 drops, while normal pupil does not. Ref:AK Khurana 4thE pg 293 