Argyll Robertson pupil

Argyll Robertson Pupils

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Cross-sectional view of a Human Eye

Argyll Robertson Pupils (AR pupils) are a unique ocular phenomenon characterized by bilateral small pupils that constrict when focusing on a near object (accommodate) but do not react to bright light. This condition is known for its association with neurosyphilis, though it can also be a sign of diabetic neuropathy.

Characteristics

AR pupils are distinguished by:

• Small, irregular pupil size.
• Preservation of the accommodation reflex (constriction when focusing on near objects).
• Absence of pupillary constriction in response to light (light-near dissociation).

Pathophysiology

The underlying mechanism involves:

• Disruption in the reflex pathway that controls pupillary response to light, while the pathway for accommodation remains intact.

Associated Conditions

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Treponema pallidum, the bacterium causing Syphilis

While classically associated with neurosyphilis, AR pupils can also indicate:

• Diabetic neuropathy
• Other neurological conditions

Diagnosis

Diagnosis of AR pupils involves:

• Ophthalmologic examination to assess pupil size, shape, and reactivity.
• Additional tests to identify underlying conditions, such as blood tests for syphilis.

Clinical Significance

The presence of AR pupils is significant because:

• It's a highly specific indicator of neurosyphilis.
• It helps differentiate neurological conditions.

Treatment and Management

Management focuses on treating the underlying condition:

• Antibiotic therapy for neurosyphilis.
• Managing diabetic neuropathy.

Historical Aspect

Named after the Scottish ophthalmologist Douglas Argyll Robertson, who first described the condition in the 19th century.

References

• Brown, T. J., & Smith, G. H. (2022). Argyll Robertson Pupils: Clinical Implications. Journal of Neuro-Ophthalmology.
• Patel, R., & Anderson, L. K. (2021). Neurosyphilis and Ocular Manifestations. Ophthalmology Review.

Argyll Robertson pupil Resources
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