Argyll Robertson Pupil

What’s going on?

The patient has a pupil abnormality classically related to neurosyphilis. The cerebral centres responsible for stimulating pupil constriction in response to a bright light and to looking at a near object (accommodation) are separate. Lesions that block the light reflex may spare the accommodation reflex. Such lesions result in an Argyll Robertson pupil.

If I examine the patient what will I find?

The pupils will not react to light, but when the patient is asked to read the pupils will miose (constrict). This is called light-near dissociation.

What if I’ve diagnosed it?

Refer soon via letter.

What will the hospital do?

Screen for leutic disease. Neuro-imaging may be indicated to exclude a space-occupying lesion.