Argyll Robertson pupil

A clinical sign associated with neurosyphilis

Argyll Robertson pupil
Argyll Robertson pupil light reflex vs accommodation reflex.jpg
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Pupils constrict on accommodation but not in response to light
Complications	N/A
Onset	N/A
Duration	N/A
Types	N/A
Causes	Neurosyphilis, diabetes mellitus, multiple sclerosis
Risks	N/A
Diagnosis	Clinical examination
Differential diagnosis	N/A
Prevention	N/A
Treatment	Treat underlying cause
Medication	N/A
Prognosis	N/A
Frequency	N/A
Deaths	N/A

Argyll Robertson pupil is a clinical sign characterized by pupils that constrict when focusing on a near object (accommodation) but do not constrict when exposed to bright light (light-near dissociation). This condition is classically associated with neurosyphilis, a late manifestation of syphilis infection, but can also be seen in other conditions such as diabetes mellitus and multiple sclerosis.

Pathophysiology

The underlying mechanism of Argyll Robertson pupil involves damage to the pretectal area of the midbrain, which disrupts the pupillary light reflex pathway while sparing the accommodation reflex pathway. This results in the characteristic light-near dissociation.

Clinical Presentation

Patients with Argyll Robertson pupil typically present with small, irregular pupils that do not constrict in response to light but do constrict when focusing on a near object. This sign is often bilateral and is considered a hallmark of neurosyphilis.

Diagnosis

Diagnosis of Argyll Robertson pupil is primarily clinical, based on the observation of light-near dissociation. Further investigation may include serological tests for syphilis, such as the Venereal Disease Research Laboratory (VDRL) test or the Rapid Plasma Reagin (RPR) test, to confirm the presence of neurosyphilis.

Treatment

Treatment of Argyll Robertson pupil involves addressing the underlying cause. In the case of neurosyphilis, this typically involves antibiotic therapy with penicillin. Management of other associated conditions, such as diabetes mellitus or multiple sclerosis, may also be necessary.

History

The condition is named after Douglas Argyll Robertson, a Scottish ophthalmologist who first described the phenomenon in the 19th century. His observations were based on patients with syphilis who exhibited this unique pupillary response.

Also see

• Neurosyphilis
• Pupillary light reflex
• Accommodation reflex
• Syphilis
• Diabetes mellitus
• Multiple sclerosis

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  Argyll Robertson pupil