Argyll Robertson pupil

Argyll Robertson Pupils

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

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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