com became available and was found to be frequently positive in patients with Argyll Robertson ( AR) pupils, the popularity of Argyll Robertson's pupillary sign increased. Stanley Thompson, MD, Ginniff Brooks 2096 Krestel Ridge SW, Oxford, IA 52322 E- mail: thompson ® ginniff. After 1908, when Wassermann's serologic test for syphilis Neuxo- ophthalmology Unit, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa. This observation was soon confirmed at a rate of three to four publications per year and was pronounced a useful clinical sign for syphilis ( 1). (/ Neuro- Ophthalmol 2006 26: 134- 138) Nearly a century and a half ago, Argyll Robertson pointed out that some patients with tabes dorsalis had small pupils that constricted poorly if at all to light yet constricted promptly when the patients viewed a near object (" light- near dissociation"). Until better evidence settles the localization of the AR pupil, it is appropriate to screen patients with bilateral tonic pupils for syphilis. If segmental iris sphincter palsy is found and the light- near dissociation has tonic features, one must conclude that the mechanism of the pupil disorder is a ciliary ( peripheral) rather than a midbrain ( central) denervation. Resolving the issue about the location of the syphilitic lesion that produces the AR pupil will depend on careful examination of patients with techniques designed to disclose segmental palsy of the iris. However, lesions in this region have not been reliably demonstrated in syphilis. Because the AR pupil lacks these features, it has been attributed to a dorsal midbrain lesion that interrupts the pupillary light reflex pathway but spares the more ventral pupillary near reflex pathway. Such features are considered typical of the light- near dissociation of Adie syndrome and of neuropathic tonic pupils, where damage to the ciliary ganglion or ciliary nerves is believed to be the mechanism. Most descriptions of the AR pupil do not mention segmental iris sphincter constriction, or slow, sustained constriction with a near vision effort. Kardon, MD, PhD Abstract: The Argyll Robertson ( AR) pupil has been denned as a pupil that is small and constricts poorly to direct light but briskly when a target within reading distance is viewed (" light- near dissociation"). Until better evidence settles the localization of the AR pupil, it is appropriate to screen patients with bilateral tonic pupils for syphilis. If segmental iris sphincter palsy is found and the light-near dissociation has tonic features, one must conclude that the mechanism of the pupil disorder is a ciliary (peripheral) rather than a midbrain (central) denervation. Resolving the issue about the location of the syphilitic lesion that produces the AR pupil will depend on careful examination of patients with techniques designed to disclose segmental palsy of the iris. Such features are considered typical of the light-near dissociation of Adie syndrome and of neuropathic tonic pupils, where damage to the ciliary ganglion or ciliary nerves is believed to be the mechanism. The Argyll Robertson (AR) pupil has been defined as a pupil that is small and constricts poorly to direct light but briskly when a target within reading distance is viewed ("light-near dissociation"). Iris, physiopathology Mesencephalon, physiopathology Neurosyphilis, complications Neurosyphilis, diagnosis Pupil Disorders, diagnosis Pupil Disorders, etiology Pupil Disorders, physiopathology Reflex, Pupillary, physiology Visual Pathways, physiopathology Neuro-opthalmology Unit, Department of Opthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, USA. © North American Neuro-Ophthalmology Society Journal of Neuro-Ophthalmology, June 2006, Volume 14, Issue 2
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