Argyll Robertson pupil

39 Argyll Robertson pupil



Instruction


Examine this patient’s eyes.



Salient features



History




• Ask the patient about lancinating pains


• History of multiple sclerosis, sarcoidosis or syphilis


• Difficulty in walking (remember the gait in tabes dorsalis).



Examination




• The pupils are small and irregular


• Light reflex is absent


• Accommodation reflex is intact (Fig. 39.1)


• There may be depigmentation of the iris


• Bilateral ptosis and marked overcompensation by frontalis muscle (in tabes doralis).


image

Fig. 39.1 Argyll Robertson pupil. (A) Pupil fails to constrict to light. (B) Pupil constricts to accommodation.


Proceed by telling the examiner that you would like to do the following:



• Examine for vibration and position sense


• Test for Romberg’s sign and deep tendon reflexes (decreased)


• Check syphilitic serology


• Check urine sugar.


Remember that these pupils show little response to atropine, physostigmine or methacholine.



Diagnosis


This patient has Argyll Robertson pupil (lesion) and you would like to investigate for underlying neurosyphilis or leutic infection (aetiology).

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Argyll Robertson pupil

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