Argyll Robertson pupil

(Redirected from Argyll-Robertson Pupil)
Jump to navigation Jump to search
Argyll Robertson pupil
ICD-10 A52.1, H58.0
ICD-9 094.89, 379.45
DiseasesDB 33036

WikiDoc Resources for Argyll Robertson pupil

Articles

Most recent articles on Argyll Robertson pupil

Most cited articles on Argyll Robertson pupil

Review articles on Argyll Robertson pupil

Articles on Argyll Robertson pupil in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Argyll Robertson pupil

Images of Argyll Robertson pupil

Photos of Argyll Robertson pupil

Podcasts & MP3s on Argyll Robertson pupil

Videos on Argyll Robertson pupil

Evidence Based Medicine

Cochrane Collaboration on Argyll Robertson pupil

Bandolier on Argyll Robertson pupil

TRIP on Argyll Robertson pupil

Clinical Trials

Ongoing Trials on Argyll Robertson pupil at Clinical Trials.gov

Trial results on Argyll Robertson pupil

Clinical Trials on Argyll Robertson pupil at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Argyll Robertson pupil

NICE Guidance on Argyll Robertson pupil

NHS PRODIGY Guidance

FDA on Argyll Robertson pupil

CDC on Argyll Robertson pupil

Books

Books on Argyll Robertson pupil

News

Argyll Robertson pupil in the news

Be alerted to news on Argyll Robertson pupil

News trends on Argyll Robertson pupil

Commentary

Blogs on Argyll Robertson pupil

Definitions

Definitions of Argyll Robertson pupil

Patient Resources / Community

Patient resources on Argyll Robertson pupil

Discussion groups on Argyll Robertson pupil

Patient Handouts on Argyll Robertson pupil

Directions to Hospitals Treating Argyll Robertson pupil

Risk calculators and risk factors for Argyll Robertson pupil

Healthcare Provider Resources

Symptoms of Argyll Robertson pupil

Causes & Risk Factors for Argyll Robertson pupil

Diagnostic studies for Argyll Robertson pupil

Treatment of Argyll Robertson pupil

Continuing Medical Education (CME)

CME Programs on Argyll Robertson pupil

International

Argyll Robertson pupil en Espanol

Argyll Robertson pupil en Francais

Business

Argyll Robertson pupil in the Marketplace

Patents on Argyll Robertson pupil

Experimental / Informatics

List of terms related to Argyll Robertson pupil

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Argyll Robertson pupils (“AR pupils”) are bilateral small pupils that constrict when the patient focuses on a near object (they “accommodate” with near vision), but do not constrict when exposed to bright light (they do not “react” to light). They were formerly known as "prostitute's pupils" because of their association with syphilis and because, like a prostitute, they “accommodate but do not react.”[1]). They are a highly specific sign of neurosyphilis. Pupils that “accommodate but do not react” are said to show light-near dissociation. A video of AR pupils and light-near dissociation is available at http://content.lib.utah.edu/u?/EHSL-Moran-Neuro-opth,60

AR pupils are extremely uncommon in the developed world. There is continued interest in the underlying pathophysiology, but the scarcity of cases makes ongoing research difficult.

Historical Perspective

The AR pupil was named after Douglas Moray Cooper Lamb Argyll Robertson, a Scottish ophthalmologist who noted the association with syphilis in 1869.[2] When serological tests for syphilis became available, patients with AR pupils usually tested positive for syphilis. The AR pupil became known as a reliable clinical sign of syphilis.

In the early 20th century, Adie described a second type of pupil that could “accommodate but not react.” Adie’s tonic pupil is usually associated with a benign peripheral neuropathy (Adie syndrome), not with syphilis.[3]

When penicillin became widely available in the 1940s, the prevalence of AR pupils (which develop only after decades of untreated infection) decreased dramatically. AR pupils are now quite rare. A patient whose pupil “accommodates but does not react” almost always has a tonic pupil, not an AR pupil.

In the 1950s, Loewenfeld[4] distinguished between the two types of pupils by carefully observing the exact way in which the pupils constrict with near vision. The near response in AR pupils is brisk and immediate. The near response in tonic pupils is slow and prolonged.

Pathophysiology

The two different types of near response are caused by different underlying disease processes. Adie's pupil is caused by damage to peripheral pathways to the pupil (parasympathetic neurons in the ciliary ganglion that cause pupillary constriction to bright light and with near vision). The AR pupil is thought to be caused by damage to central pathways for pupillary constriction. Specifically, the AR pupil is thought to be caused by selective damage to pathways from the retina to the Edinger-Westphal nucleus. These light-sensitive pathways allow the pupil to constrict to bright light. The accommodation pathways – pathways to the Edinger-Westphal nucleus that cause the pupils to constrict with near vision – are thought to be spared because of their more ventral course in the brainstem.

The exact relationship between syphilis and the two types of pupils (AR pupils and tonic pupils) is not known at the present time. The older literature on AR pupils did not report the details of pupillary constriction (brisk vs. tonic) that are necessary to distinguish AR pupils from tonic pupils. Tonic pupils can occur in neurosyphilis.[5] It is not known whether neurosyphilis itself (infection by Treponema pallidum) can cause tonic pupils, or whether tonic pupils in syphilis simply reflect a coexisting peripheral neuropathy.

Thompson and Kardon (2006)[6] summarize the present view:

The evidence supports a midbrain cause of the AR pupil, provided one follows Loewenfeld’s definition of the AR pupil as small pupils that react very poorly to light and yet seem to retain a normal pupillary near response that is definitely not tonic.
To settle the question of whether the AR pupil is of central or peripheral origin, it will be necessary to perform iris transillumination (or a magnified slit-lamp examination) in a substantial number of patients who have a pupillary light-near dissociation (with and without tonicity of the near reaction), perhaps in many parts of the world.

Parinaud's syndrome

A third cause of light-near dissociation is Parinaud syndrome, also called dorsal midbrain syndrome. This uncommon syndrome involves vertical gaze palsy associated with pupils that “accommodate but do not react.”[7] The causes of Parinaud syndrome include brain tumors (pinealomas), multiple sclerosis and brainstem infarction.

Due to the lack of detail in the older literature and the scarcity of AR pupils at the present time, it is not known whether syphilis can cause Parinaud syndrome. It is not known whether AR pupils are any different from the pupils seen in other dorsal midbrain lesions.

Related Chapters

References

  1. http://www.fpnotebook.com/EYE89.htm
  2. http://www.whonamedit.com/doctor.cfm/260.html
  3. Kawasaki A. Physiology, assessment, and disorders of the pupil. Curr Opin Ophthalmol 10(6):394-400, 1999
  4. Thompson HS, Kardon RH. Irene E. Loewenfeld, PhD Physiologist of the Pupil. J Neuroophthalmol 26(2):139-148, 2006
  5. Fletcher WA, Sharpe JA (1986). "Tonic pupils in neurosyphilis". Neurology. 36 (2): 188–92. PMID 3945389.
  6. Thompson HS, Kardon RH (2006). "The Argyll Robertson pupil". Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society. 26 (2): 134–8. doi:10.1097/01.wno.0000222971.09745.91. PMID 16845316.
  7. http://content.lib.utah.edu/u?/EHSL-Moran-Neuro-opth,55



de:Argyll-Robertson-Zeichen it:Segno di Argyll-Robertson no:Argyll Robertsons pupill


Template:WH Template:WS