39 Argyll Robertson pupil
Examination
• The pupils are small and irregular
• 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).

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)
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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