Bilateral Tonic Pupils in the Absence of Pupillary Cholinergic Supersensitivity.

We report a 24-year-old woman with a presenting complaint of bilateral dilated pupils. The pupils were found to be dilated in bright and dim room lighting with minimal light reaction, showed an accommodation response, but did not demonstrate cholinergic supersensitivity. Neurological examination and neuro-imaging of the patient were normal. Syphilis serology was negative. This case emphasises that tonic pupil may be found in the absence of pupillary cholinergic supersensitivity.