Argyll Robertson pupils
A reflex iridoplegia: characterized by small, irregular, unequal pupils, with near-light dissociation; absence of a miotic reaction to both direct and consensual light with preservation of the accommodation reflex. Classically associated with neurosyphilis.
Rare since the advent of penicillin. Most often found on Medical school exams…
Other causes of reflex iridoplegia include Holmes-Adie syndrome, Parinaud syndrome, diabetic neuropathy, brain injury, thiamine deficiency, and mitral regurgitation.
‘I could not observe any contraction of either pupil under the influence of light, but, on accommodating the eyes for a near object, both pupils contracted.’
Although it was many years and required the contribution of multiple physicians including Dr Erb of Heidelberg (1881), Babinski and Charpentier (1899) and finally confirmed by the discovery of the Wassermann reaction (1906) that the association with syphilis was widely accepted.
The anatomy and physiology were not well defined and Argyll Robertson never taught that the disease was pathognomonic for neurosyphilis, however, if found it needs to be excluded.
- Douglas Argyll Robertson (1837–1909)
- Prostitute’s pupils
- AR pupils
- Robertson DA. On an interesting series of eye symptoms in a case of spinal disease, with remarks on the action of belladonna on the iris. Edin Med J. 1869;14:696–708 [PMC5326971]
- Syed SA, Saberi A. Argyll Robertson pupil. Hosp Physician 1999; 1:21–22
- Loewenfeld JE. The Argyll Robertson pupil, 1869–1969. A critical survey of the literature. Surv Ophthalmol 1969;14(3):199–299 [PMID 19093312]