NationMaster - Encyclopedia: Argyll Robertson pupil

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 The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // A00-A79 - Bacterial infections, and other intestinal infectious diseases, and STDs (A00-A09) Intestinal infectious diseases (A00) Cholera (A01) Typhoid and paratyphoid fevers (A010) Typhoid fever (A02) Other Salmonella infections (A03) Shigellosis (A04) Other bacterial intestinal infections (A040) Enteropathogenic Escherichia coli infection (A045) Campylobacter enteritis (A046) Enteritis due to Yersinia... // H00-H59 - Diseases of the eye and adnexa (H00-H06) Disorders of eyelid, lacrimal system and orbit (H00) Hordeolum and chalazion (H000) Hordeolum and other deep inflammation of eyelid (H001) Chalazion (H01) Other inflammation of eyelid (H010) Blepharitis (H011) Noninfectious dermatoses of eyelid (H02) Other disorders of eyelid (H020) Entropion... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... Light from a single point of a distant object and light from a single point of a near object being brought to a focus by changing the curvature of the lens. ...

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.

History

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. Douglas Moray Cooper Lamb Argyll Robertson (1837-1909} was a Scottish ophthalmologist and surgeon. ...

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] Adie syndrome, also Adies syndrome, is caused by damage to the postganglionic fibers of the parasympathetic innervation of the eye and characterized by a tonically dilated pupil. ...

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. Adie syndrome, also Adies syndrome, Adies Tonic Pupil or Holmes-Adies syndrome, is caused by damage to the postganglionic fibers of the parasympathetic innervation of the eye and characterized by a tonically dilated pupil. ... The ciliary ganglion is small parasympathetic ganglion lying in the orbit between the optic nerve and the lateral rectus muscle that is associated with the nasociliary nerve (a branch of the ophthalmic division of the trigeminal nerve). ... The Edinger-Westphal nucleus is the accessory parasympathetic nucleus of the oculomotor nerve, supplying the constricting muscles of the iris. ...

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.

Parinaud 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 syphillis can cause Parinaud syndrome. It is not known whether AR pupils are any different from the pupils seen in other dorsal midbrain lesions.

See also

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References

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External links

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Homonymous hemianopsia is a medical term for a type of partial blindness resulting in a loss of vision in the same visual field of both eyes. ... Quadrantanopia (or quadrant anopia, as two words) refers to an anopia affecting a quarter of the field of vision. ... Color blindness in humans is the inability to perceive differences between some or all colors that other people can distinguish. ... Achromatopsia is the inability to see color. ... Nyctalopia (Greek for night blindness) is a condition making it difficult or impossible to see in the dark. ... Blindness is the condition of lacking visual perception due to physiological or psychological factors. ... Low vision is alternatively a general term used to describe lowered visual acuity, and a specific legal term in Canada and the United States used to designate someone with vision of 20/70 or less in the better eye with correction. ... The human eye The pupil is the central transparent area (showing as black). ... Anisocoria is a condition characterized by an unequal size of the pupils. ... The pupil dilates instead of constricting when the light moves from the good eye to the bad eye. ... Marcus Gunn Phenomenon (a. ... Adie syndrome, also Adies syndrome, is caused by damage to the postganglionic fibers of the parasympathetic innervation of the eye and characterized by a tonically dilated pupil. ... Infection is also the title of an episode of the television series Babylon 5; see Infection (Babylon 5). ... Binomial name Onchocerca volvulus Bickel 1982 Onchocerciasis (pronounced ) or river blindness is the worlds second leading infectious cause of blindness. ... Nystagmus is involuntary eye movement that can be part of the vestibulo-ocular reflex (VOR), with the eyes moving first in the direction of the lesioned side (slow phase) followed by a quick correction (fast phase) to the opposite side or away from the lesioned side. ... For other uses, see Floater (disambiguation). ... Leberâ€™s hereditary optic neuropathy (LHON) or Leber optic atrophy is a mitochondrially inherited (mother to all offspring) form of acute or subacute loss of central vision that may lead to degeneration of retinal ganglion cells (RGCs) and their axons; this affects predominantly young adult males. ... Many primary care physicians often deal with patients with red eyes In medicine, red eye is a non-specific term to describe an eye that appears red due to illness, injury, or some other condition. ... A fungal keratitis is an inflammation of the eyes cornea (called keratitis) that results from infection by a fungal organism. ... Xerophthalmia (Greek for dry eyes) is a medical condition in which the eye doesnt produce tears. ... Aniridia is a rare congenital condition characterized by the underdevelopment of the eyes iris. ...

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