Argyll Robertson pupils

Argyll Robertson pupils are a specific type of pupil abnormality that is characterized by pupils that constrict when the patient focuses on a near object (they accommodate), but do not constrict when exposed to bright light (they do not react to light). This condition is often associated with neurosyphilis, particularly the tertiary stage of the disease.

Etiology

The exact cause of Argyll Robertson pupils is not fully understood. However, it is most commonly associated with neurosyphilis, a neurological complication of syphilis. Other conditions that may cause Argyll Robertson pupils include diabetes mellitus, multiple sclerosis, and chronic alcoholism.

Pathophysiology

The abnormal reaction of the pupils in Argyll Robertson pupils is thought to be due to damage to the pretectal area of the midbrain, which is responsible for controlling the pupillary light reflex. The accommodation reflex, which is controlled by a different part of the brain, remains intact.

Clinical Features

Patients with Argyll Robertson pupils typically present with pupils that are small and irregular in shape. The pupils do not react to light, but they do constrict when the patient focuses on a near object. This is often described as "accommodation without reaction". Other symptoms may include blurred vision, double vision, and light sensitivity.

Diagnosis

Diagnosis of Argyll Robertson pupils is primarily based on clinical examination. The doctor will shine a light into the patient's eyes to check for the pupillary light reflex and will also ask the patient to focus on a near object to check for the accommodation reflex. Additional tests may be performed to confirm the diagnosis and to identify any underlying conditions.

Treatment

Treatment for Argyll Robertson pupils primarily involves managing the underlying condition. For example, if the condition is caused by neurosyphilis, the patient will be treated with antibiotics to combat the syphilis infection.

See Also

• Pupil
• Neurosyphilis
• Syphilis
• Pupillary light reflex
• Accommodation reflex