An Argyll Robertson pupil is small, irregular, and reacts poorly to light but constricts normally for near focus. It is classically associated with neurosyphilis.
Characteristics
The key feature is light-near dissociation.
- Bilateral miotic pupils with minimal or absent response to direct and consensual light
- Preserved constriction during accommodation and convergence
- Often accompanied by other neurological signs of dorsal midbrain or syphilitic damage
- Syphilis serology and neuroimaging help confirm the underlying cause
Management
Treatment focuses on the underlying disease.
- Appropriate antibiotic therapy for neurosyphilis after infectious disease consultation
- Neurological assessment for additional deficits
- Monitoring of visual function and fields
- Pupil changes themselves are usually permanent even after treatment
