Neuro-Ophthalmic
Argyll Robertson Pupil
Also known as: argyll robertson pupil, argyll robertson pupils, AR pupil, light-near dissociation small pupils, small irregular pupils, syphilitic pupil, neurosyphilis pupil, tabes dorsalis pupil
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Small, irregular pupils that react poorly or not at all to light but constrict briskly to a near target. They are almost always in both eyes, though often unequal, and they dilate poorly in the dark. The classic cause is late syphilis affecting the nervous system. The eye finding may be the first clue to an infection that is treatable. The optometrist does not need to establish the cause. The task is to recognise the pupil pattern, look for other eye signs, and send the patient for systemic investigation through the GP when there is no known, treated history of syphilis.
Recognition
Symptoms: what patients report
- Usually no eye symptoms; the pupils are noticed by the examiner
- Difficulty seeing in dim light because the pupils stay small
- Possible symptoms of the underlying disease: unsteadiness, shooting leg pains, numb feet, memory or personality change, hearing loss
- Blur, floaters or a red eye if there is syphilitic eye inflammation as well
Signs: what the examination shows
- Small pupils in both eyes, often unequal and irregular in outline
- Minimal or absent direct and consensual light response
- Intact, brisk constriction to a near target (light-near dissociation)
- Poor dilation in the dark
- Normal lids and eye movements
- Iris atrophy may be seen
- Possible signs of syphilitic eye disease: uveitis, optic disc swelling or pallor, chorioretinitis
What OptoGuide™ covers for argyll robertson pupil
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting