Argyll Robertson Pupil

Argyll Robertson Pupil
SYMPTOMS Typically asymptomatic
SIGNS Almost always bilateral
Miotic pupils (Usually < 2mm), Irregular oval shaped pupils, Light-near dissociation, Normal and brisk redilation, Slow dilation with mydriatics, Typically associated with iris atrophy
Argyll Robertson pupils usually do not show slow sustained constriction with near response and segmental contractions of the iris sphincter
Chronic Argyll Robertson pupils will eventually lose ability to constrict at near
WORK-UP Pupils | EOMs | Full eye exam with dilation | Ptosis testing | Cranial nerve testing
TREATMENT Monitor pupils | Refer to PCP/neurology for additional lab testing and treatment of underlying cause
FOLLOW-UP Once underlying cause is determined and treated, monitor in 3-4 months
ADDITIONAL LAB | TESTS 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
ETIOLOGY Occurs due to lesions in the dorsal midbrain that disrupt the pretectal oculomotor fibers
Typically associated with neurosyphilis
DIFFERENTIAL DX Diabetic neuropathy, Neurosarcoidosis, Lyme disease, Adie’s syndrome, Dorsal midbrain syndrome