Argyll robertson pupil Definition, Symptoms, Causes, Treatment

   

Argyll Robertson pupil is a type of reflex iridoplegia along with miosis and irregular shape. There is a loss of pupillary reflex to direct light and have normal constriction of pupil while seeing near objects. It is a symptom of tabetic neurosyphilis. Argyll Robertson pupil is a miotic pupil which cannot reflect to direct light but efforts towards accommodate light. Its been more than a century, this condition is describing. This reaction of pupil is a way to confirm the functionality of the optic nerve pathway. It is considered a neurological disorder biomarker like in neurosyphilis, neuro sarcoidosis and multiple sclerosis.

The diagnostic test of Argyll Robertson pupil does not require any special equipment and can be diagnosed easily. The pupil better respond to accommodation as compare to stimulus of light. As miotic pupil occurs due to lesion in dorsally placed fibers which are responsible for light response. This condition was 1st described by a scientist named Douglas Argyll and named this disease after his own name. Pathophysiology behind Argyll Robertson pupil is not clear yet. Some scientist believe that the rostal midbrain in the vicinity of the sylvian aqueduct of the 3rd ventricle is area of damage.



Argyll robertson pupil Definition, Symptoms, Causes, Treatment

Argyll robertson pupil Symptoms


Argyll Robertson pupil shows consistent pupillary findings with the passage of time from months to years. 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. Other symptoms reported are iris atrophies along with loss in its radial folds. Crypts are also reported. Vision is effected and patient is not able to see distinct objects but can see nearly placed objects. It is similar to near sightedness in which far vision is blurred and near vision is accurate.

Argyll robertson pupil Causes

       
The main mechanism or etiology is still unclear but it can occurs secondary to many diseases like syphilis. The Argyll Robertson pupil results in lesion to the pretectal nuclei in the mid brain. Scientist believe that roastal midbrain present in vicinity of cerebral aqueduct of third ventricle is the main area of damage regarding Argyll Robertson pupil. This area involves pupillary fibers which are responsible for reflecting light. If it occurs secondary to syphilis, then pupil generally appears to be unequal and irregular. Atrophy and depigmentation are also reported as rare causes.

Argyll robertson pupil Treatment

         
Treatment regarding Argyll Robertson pupil is not discovered yet but its underlying cause must be treated to cure it. Most of the time, its leading cause is syphilis, which should be treated 1st. Medication therapy of syphilis include intravenous administration of penicillin doxycycline and tetracycline can be administered instead of penicillin. When the treatment has started, it is important to perform plasma regain test. This test measures the level of antibodies against cardiolipin but do not calculate level of antibiotics against treponema. Once a person get infected, this test will always come positive because of presence of antibodies against it.

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