Argyll Robertson Pupil

Related video:    • Pupillary Light Reflex Pathway  

Argyll Robertson Pupil describes the physical exam finding of small bilateral pupils that do not constrict when exposed to bright light but do constrict when focused on a nearby object. This finding is highly specific for late-stage syphilis. Argyll Robertson pupil was first described by Scottish ophthalmologist and surgeon, Dr. Douglas Argyll Robertson in the mid-1860s.
Argyll Robertson pupil is found in late-stage syphilis, a disease caused by the spirochete Treponema pallidum. Neurosyphilis occurs due to an invasion of the cerebrospinal fluid by the spirochete which likely occurs soon after the initial acquisition of the disease. The exact pathophysiology leading to the Argyll Robertson pupil, however, remains unknown.
The patient with Argyll Robertson pupil will show small, irregular pupils with light-near dissociation: absent light reflex, prompt constriction with near accommodation. Symptoms are usually bilateral and have a gradual onset of months to years. The pupils will initially have a sluggish response to light, progressing eventually to a complete absence of the light reflex.

References:
Belliveau AP, Somani AN, Dossani RH. Pupillary Light Reflex. [Updated 2020 Apr 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NB...
Dichter SL, Shubert GS. Argyll Robertson Pupil. [Updated 2020 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NB...

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