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Miotic pupils (Usually < 2mm), Irregular oval shaped pupils, Light-near dissociation, Normal and brisk redilation, Slow dilation with mydriatics, Typically associated with iris atrophy
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Argyll Robertson pupils usually do not show slow sustained constriction with near response and segmental contractions of the iris sphincter
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Chronic Argyll Robertson pupils will eventually lose ability to constrict at near
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WORK-UP
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Pupils | EOMs | Full eye exam with dilation | Ptosis testing | Cranial nerve testing
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TREATMENT
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Monitor pupils | Refer to PCP/neurology for additional lab testing and treatment of underlying cause
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FOLLOW-UP
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Once underlying cause is determined and treated, monitor in 3-4 months
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ADDITIONAL LAB | TESTS
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HbA1c | Fasting blood sugar | VDRL/RPR | FTA-ABS/MHA-TA/T | pallidum-particle agglutination | ACE | Lyme titer | MRI of the brain with and without contrast
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ETIOLOGY
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Occurs due to lesions in the dorsal midbrain that disrupt the pretectal oculomotor fibers
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Typically associated with neurosyphilis
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DIFFERENTIAL DX
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Diabetic neuropathy, Neurosarcoidosis, Lyme disease, Adie’s syndrome, Dorsal midbrain syndrome
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