The Argyll Robertson pupil results in lesion to the pretectal nuclei in the mid brain. The main mechanism or etiology is still unclear but it can occurs secondary to many diseases like syphilis. It is similar to near sightedness in which far vision is blurred and near vision is accurate. Vision is effected and patient is not able to see distinct objects but can see nearly placed objects. Other symptoms reported are iris atrophies along with loss in its radial folds. The abnormal functioning of pupil starts with a very sluggish response to direct light and this abnormal response to direct light leads it towards complete loss of reflection to light. Some scientist believe that the rostal midbrain in the vicinity of the sylvian aqueduct of the 3rd ventricle is area of damage.Īrgyll Robertson pupil shows consistent pupillary findings with the passage of time from months to years. Pathophysiology behind Argyll Robertson pupil is not clear yet. This condition was 1st described by a scientist named Douglas Argyll and named this disease after his own name. As miotic pupil occurs due to lesion in dorsally placed fibers which are responsible for light response. The pupil better respond to accommodation as compare to stimulus of light. The diagnostic test of Argyll Robertson pupil does not require any special equipment and can be diagnosed easily. It is considered a neurological disorder biomarker like in neurosyphilis, neuro sarcoidosis and multiple sclerosis. This reaction of pupil is a way to confirm the functionality of the optic nerve pathway. Its been more than a century, this condition is describing. Argyll Robertson pupil is a miotic pupil which cannot reflect to direct light but efforts towards accommodate light. It is a symptom of tabetic neurosyphilis. There is a loss of pupillary reflex to direct light and have normal constriction of pupil while seeing near objects. Furthermore, a lumbar puncture is suggested in all HIV patients with syphilis regardless of their presenting symptoms.ĬSF findings indicative of neurosyphilis will show greater than 20 WBC/microL, and return positive for VRDL and intrathecal pallidum antibody index.Argyll Robertson pupil is a type of reflex iridoplegia along with miosis and irregular shape. Lumbar puncture is required in the evaluation of a patient with known syphilis presenting with these same symptoms. More commonly, however, non-treponemal blood work for VRDL (venereal disease research laboratory) or RPR (rapid plasma reagin) is sent to rule in the disease, and then confirmatory testing assessing for FTA-ABS (fluorescent treponemal antibody absorption), TPPA ( Treponema pallidum particle agglutination assay) or EIAs (syphilis enzyme immunoassays) is obtained.Ī lumbar puncture can be useful in the diagnosis of neurosyphilis in a patient with an unknown syphilis history who is presenting with neurologic and ocular disease that could be consistent with the disease. The gold standard remains visualization of spirochetes on darkfield microscopy. Additionally globally, reports have indicated that syphilis has been on the rise in conjunction with the global HIV/AIDs epidemic. The US CDC data estimates that 5% of MSM with syphilis are also infected with HIV. There is a high rate of co-infection with HIV in those MSM patients who have contracted syphilis.

This may be due to the fact that syphilis is more common in MSM, many of whom concurrently also have HIV, or it could reflect two separate groups with increased susceptibility.

From 2000 to 2016, the rise in reported syphilis cases is primarily due to increased cases in the men who have sex with men population. The CDC acknowledges, however, that the disease is likely under-reported. According to the CDC: there were 30,676 cases of late and late latent cases of neurosyphilis reported in the United States in 2016. However, in the modern era, the number of cases of primary and secondary syphilis have been increasing every year since 2001, and continue to rise. The exam finding of Argyll Robertson pupils has been rare in the developed world since the advent of penicillin in the 1940s.

Argyll robertson pupil