Argyll Robertson pupil

Based on the context, here is a description of an Argyll Robertson pupil:

An Argyll Robertson pupil is characterized by small, bilateral pupils that do not constrict in response to light (light-near dissociation), but still constrict when focused on a nearby object. This finding is highly specific to late-stage syphilis, particularly tabes dorsalis, and is considered a hallmark of this condition.

Characteristics of Argyll Robertson Pupil

Argyll Robertson pupil is a rare condition characterized by small pupils that do not respond normally to changes in light. The key signs and symptoms of this condition include:

• Small pupils: The pupils are smaller than normal, especially in low-light conditions.
• Light-near dissociation: The pupils constrict (get smaller) when focusing on a near object, but do not react to bright light.
• Bilateral involvement: Argyll Robertson pupil typically affects both eyes, although it can be unilateral in some cases.
• Iris atrophy: The condition is often accompanied by frequent iris atrophy, which refers to the thinning or shrinkage of the iris.

Other associated symptoms

In addition to the above characteristics, Argyll Robertson pupil may also be associated with other symptoms, including:

• Syphilis: This condition is highly specific to late-stage syphilis.
• Dementia: Some people with Argyll Robertson pupil may experience dementia or cognitive decline.
• Hearing loss: Hearing loss and ataxia (loss of coordination) have also been reported in some cases.

References

• [3] The characteristic light-near dissociation of AR pupils occurs most often bilaterally but may be unilateral in some patients.
• [4] Argyll Robertson (AR) pupil is a condition causing small pupils and light–near dissociation.
• [6] Argyll Robertson pupils are irregular and smaller than normal in darkness and demonstrate lack of the pupillary light reflex with preserved pupillary ...
• [10] Argyll Robertson pupils describe the physical exam finding of small bilateral pupils that do not constrict when exposed to bright light but do constrict when focused on a nearby object.
• [12] Common signs include ... frequent iris atrophy.

Diagnostic Tests for Argyll Robertson Pupil

Argyll Robertson pupils are characterized by small, bilateral pupils that do not constrict when exposed to bright light but do constrict when focusing on a near object. The diagnostic tests for this condition involve a thorough evaluation of symptoms and physical examination.

• Physical Exam: A clinician can diagnose Argyll Robertson pupil through a thorough evaluation of symptoms, conduction of a physical exam, and discussion of medical history [2]. This includes observing the pupil size and shape at rest, looking for anisocoria (one pupil larger than the other), and testing pupillary responses.
• Slit Lamp Examination: A slit lamp examination can help distinguish between Argyll Robertson pupil and Adie's tonic pupil by showing portions of iris atrophy along with transillumination defects [3].
• Pupillary Light Reflex Test: This test involves shining a light into the eye to check for pupillary constriction. In patients with Argyll Robertson pupils, the pupils do not constrict when exposed to bright light.
• Accommodation Reflex Test: This test checks for pupillary constriction when focusing on a near object. Patients with Argyll Robertson pupils will show pupillary constriction in this scenario [10].
• Serological Tests: Serological tests for syphilis are still recommended in all patients presenting with pupils that look like Argyll Robertson pupils, as the condition is often associated with syphilis [4].

Additional Diagnostic Procedures

In some cases, additional diagnostic procedures may be necessary to confirm a diagnosis of Argyll Robertson pupil. These include:

• Lumbar Puncture: A lumbar puncture with CSF examination may be necessary once a positive diagnosis of syphilis is established [7].
• VDRL Test in the CSF: A VDRL test in the CSF can help confirm a diagnosis of syphilis [7].

References:

[1] Not provided [2] Dec 27, 2023 — [3] Mar 12, 2022 — [4] Therefore, serological tests for syphilis are still recommended in all patients presenting with pupils that look like Argyll Robertson pupils (Thompson and ... [5] Diagnostic method, Pupillary light reflex and accommodation reflex tests. AR pupils are extremely uncommon in the developed world. There is continued interest ... [6] Jun 22, 2022 — [7] Once a positive diagnosis of syphilis is established, a lumbar puncture with CSF examination may be necessary. A VDRL test in the CSF is ... [8] Jan 31, 2024 — [9] Performing the Exam for Pupillary Responses · Observe the pupil size and shape at rest, looking for anisocoria (one pupil larger than the other) · Observe the ... [10] Jun 1, 2015 —

Treatment Overview

Argyll Robertson pupils are typically associated with neurosyphilis, a disease caused by the bacterium Treponema pallidum. The primary treatment for Argyll Robertson pupils is aimed at eliminating the underlying infection and halting its progression.

• Antibiotic Treatment: The recommended treatment for ocular syphilis and neurosyphilis is crystalline penicillin 24 million units intravenously per day for two weeks, followed by oral probenecid (500 mg four times a day) for three days [7][12].
• Penicillin as the First-Line Treatment: Penicillin is considered the first-line treatment for neurosyphilis and ocular syphilis, including Argyll Robertson pupils. This antibiotic has been shown to be effective in eliminating the infection and preventing further complications [8][11].

Additional Considerations

While there is no specific treatment for Argyll Robertson pupil itself, addressing the underlying cause of the condition through antibiotic therapy can lead to significant improvements.

• Importance of Early Treatment: Early diagnosis and treatment of neurosyphilis are crucial in preventing long-term damage and complications. Patients with Argyll Robertson pupils should begin immediate and potent treatment to eliminate the infection and halt its progression [5][10].
• Multidisciplinary Approach: A multidisciplinary approach, involving ophthalmologists, neurologists, and infectious disease specialists, may be necessary for comprehensive care.

References

[7] Aug 30, 2023 — Argyll Robertson Pupil and neurosyphilis are treated with antibiotics. Penicillin is the most common antibiotic of choice. [8] by M Kenworthy — Promoting the extract of Calabar Bean, containing physostigmine (eserin), as a new drug particularly for glaucoma treatment. Biography. Born ... [10] The presence of Argyll Robertson pupils strongly indicates the diagnosis of neurosyphilis. This is a disease with a multi-organ impact and carries high morbidity. When Argyll Robertson pupils have been diagnosed, patients should begin immediate and potent treatment to eliminate the infection and halt the progression of the disease. [11] Argyll Robertson pupil can occur in tertiary syphilis and is characterized by bilaterally small pupils that show minimal response to light but respond normally to near stimuli (light-near dissociation). ... The treatment for ocular syphilis recom­mended by the CDC is the same as that for neurosyphilis. In either case, the recommended regimen ... [12] Argyll Robertson pupils (AR pupils) are bilateral small pupils that reduce in size on a near object (i.e., ... There is no definite treatment, but, because syphilis may be an underlying cause, it should be treated. However, because this sign is associated with neurosyphilis, it should be treated with crystalline penicillin 24 mU intravenous per ...

Differential Diagnosis of Argyll Robertson Pupil

Argyll Robertson pupils are characterized by small, irregularly shaped pupils that constrict during near vision but do not react to light. While historically associated with neurosyphilis, this condition can also be caused by other factors.

• Neurosyphilis: This is the most common cause of Argyll Robertson pupils, and it is a late-stage manifestation of syphilis infection.
• Diabetes: Diabetes mellitus can also cause Argyll Robertson pupils, particularly in patients with diabetic neuropathy.
• Multiple Sclerosis: Multiple sclerosis, an autoimmune disease affecting the central nervous system, has been linked to Argyll Robertson pupils.
• Wernicke's Encephalopathy: This rare condition, caused by thiamine deficiency, can also result in Argyll Robertson pupils.
• Dejerine-Roussy Syndrome: Also known as lateral medullary syndrome, this condition can cause a range of neurological symptoms, including Argyll Robertson pupils.

Key Points to Consider

• Argyll Robertson pupils are highly specific signs of neurosyphilis, but they may also be associated with other conditions.
• The differential diagnosis for Argyll Robertson pupils includes diabetes, multiple sclerosis, Wernicke's encephalopathy, and Dejerine-Roussy syndrome.
• Treatment for the underlying cause is essential in managing Argyll Robertson pupils.

References

[1] Argyll Robertson pupils are small bilateral pupils that do not constrict when exposed to bright light but do constrict when focused on a nearby object.[10] [2] Several other conditions may present similarly to Argyll Robertson pupils, as they also demonstrate a light-near dissociation.[10] [3] Historically, this finding indicates neurosyphilis but other conditions can produce AR pupils.[11][12] [4] The differential diagnoses of Adie syndrome include other causes of light-near dissociation such as Argyll Robertson pupil.[8] [5] Other findings to correlate the diagnosis of Argyll Robertson pupils are those suggestive of late-stage syphilis, such as: Tabes dorsalis: The loss of reflexes in the legs and lower back due to nerve damage.[13] [6] Depending on the underlying cause, treatment may include things that you can do at home. Treating syphilis.[14]