Most descriptions of the ar pupil do not mention segmental iris sphincter constriction, or slow, sustained constriction with a near vision. Later, the argyll robertson pupil was found usually to be the result of neurosyphilis, and it became a cardinal sign of the disease. Desestret v, a third nerv e palsy with an argyll robertson pupil, idcr 2014, this is a pdf. The argyll robertson ar pupil has been defined as a pupil that is small and constricts poorly to direct light but briskly when a target within reading distance is viewed lightnear dissociation. This activity highlights the role of the interprofessional team in caring for patients with this condition. The argyll robertson ar pupil refers to small, irregularly shaped pupils bilaterally that can accommodate to a near stimulus but do not react.
The pseudoaargyll robertson pupil wiley online library. Which produces an argyll robertson pupil is unclear. However, we have not seen typical argyll robertson pupils narrow pupils unreactive to light but reactive to near vision with positive serological. The argyll robertson pupil request pdf researchgate. Chrousos and colleagues 1985 reported a child with absence of complete near re. The argyll robertson ar pupil has been defined as a pupil that is small and constricts poorly to direct light but briskly when a. The argyll robertson pupil eccles health sciences library. We are reporting a patient with no pupillary constriction on near gaze with presence. Argyll robertson pupils were named after douglas argyll robertson 18371909, a scottish ophthalmologist and surgeon who described the condition in the mid1860s in the context of neurosyphilis. The argyll robertson pupil, a miotic pupil that fails to react to direct light, has. Argyll robertson pupil is a highly specific sign of latestage syphilis.
In the early 20th century, william john adie described a second type of pupil that could accommodate but not react. He was the first president 18935 of the ophthalmological society of great britain to be chosen from the ophthalmic surgeons. Argyll robertson pupil jama neurology jama network. The light which passes through the pupil and falls on the retina gets completely absorbed by the retina so the pupil is black in colour. Nov 03, 2020 douglas moray cooper lamb argyll robertson 18371909 was a scottish ophthalmologist.
Pupil eye anatomy an overview pupil defination in hindi. Pupil abnormalities medical and health sciences the university. In 1869 he published a paper giving the first description of unusual reactions of the pupils to light and accommodation in patients with tabes dorsalis syphilis affecting the spinal. The first one, twelve pages long, appeared in 1869, in the edinburgh medical journal and was entitled, on an interesting series of eye symptoms in a case of spinal disease, with remarks of the action of. Argyll robertson pupil radiology reference article radiopaedia.
The affected pupils initially appear small, and are irregular, but as opposed to the tonic pupil do not maintain increased tone to near targets. This video gives a brief overview of the neuroanatomy of accommodation reflex and pupillary light reflex and how it is altered in argyl robertson pupil. The ar pupil was named after douglas moray cooper lamb argyll robertson, a scottish ophthalmologist who noted the association with syphilis in 1869. The pupil was found to be unresponsive to light, but to contract promptly on attempted ocular movements which involved motor neurons of the third nerve. Dreyfus 1906 saw a case of miosis and fixed pupils due to an injury of the cervical part of. Nov 03, 2020 1869 argyll robertson published his ocular clinical findings of four patients with a spinal disease, now known to be neurosyphilis, in the edinburgh medical journal. Argyll robertson ar pupils, are characterized by small and irregular pupils that have little to no constriction to light but constricts briskly to near targets lightnear dissociation. The argyll robertson ar pupil refers to small, irregularly shaped pupils bilaterally that can accommodate to a near stimulus but do not react well to direct light stimulus. I could not observe any contraction of either pupil under the influence of light, but, on accommodating the eyes for a near object, both pupils contracted. Mar 26, 2021 the pupil inside the eye is perfectly round in shape and exactly equal in size. Argyll robertson pupil presents with asymmetrically bilateral, small, and irregular pupils which respond poorly to light and respond poorly to dilation. Argyll robertson was also the first to demonstrate the cholinergic ocular effects of an extract from the calabar bean, the drug physostigmine.
This condition was christened by common accord the argyll robertson pupil, and its value as an aid to diagnosis has steadily increased. Argyll robertson pupil is usually bilateral and presents as bilaterally miotic and irregular pupils, which constrict briskly with accommodation but do not react to bright light therefore displaying lightnear dissociation 1. Argyll robertson pupil radiology reference article. Aug 08, 2020 argyll robertson pupil describes the physical exam finding of bilaterally small pupils that do not constrict when exposed to bright light but do constrict when focused on a nearby object. Tonic pupils2j also show lightnear dissociation, but slow pupillary constriction and slow redilation. Dictionary of national biography, 1912 supplementrobertson. When serological tests for syphilis became available, patients with ar pupils usually tested positive for syphilis. Historically, this finding indicates neurosyphilis but other conditions can produce ar pupils. Argyll robertson pupil is ascribed to a lesion of intercalated neurons in the midbrain or to damage of inhibitory fibers to the oculomotor nucleus loewenfeld, 1969.
Inverse argyll robertson pupil in burkitts lymphoma. Case 3 a 40yearold chinese male was involved in a road traffic accident sixteen years ago. Trigemino autonomic cephalalgia and argyll robertson pupil. Shortly after the onset of the disease, he developed bilateral optic neuritis, argyll robertson pupils, bilateral facial paralysis, signs. Most descriptions of the ar pupil do not mention segmental iris sphincter constriction, or slow, sustained constriction with a near vision effort. Trigemino autonomic cephalalgia and argyll robertson pupil scielo. Argyll robertson pupils litfl medical blog medical. Argyll robertson pupils litfl medical blog medical eponym. The essentials of the argyll robertson pupil are absolute immobility to light and unimpaired response to the accommodation. The ar pupil became known as a reliable clinical sign of syphilis.
The phenomenon of abnormal motor response following recovery. The argyll robertson ar pupil has been defined as a pupil that is small and constricts poorly to direct light but briskly when a target within reading distance is viewed lightnear. Robertson reasoned that a lesion in the ciliospinal sympathetic nerves was responsible for the syndrome. Argyll robertson pupil he also described a symptom of neurosyphilis that affects the pupils of the eye, a condition subsequently known as argyll robertson pupil. Lightnear dissociation is present in these patients. Argyll robertson pupils project gutenberg selfpublishing.
Moreover, robertson s pupil observation began to appear in several papers per year as a useful clinical sign in syphilis, and when wassermanns serologic test became available in 1908, it was found to be frequently positive in people with an argyll robertson pupil. He won the gold medal of the royal and ancient club five times, and that of the honourable company of edinburgh golfers thrice. He was the first to describe his eponymous pupillary abnormality among patients with tabes dorsalis. Articulo en pdf articulo en xml referencias del articulo como citar este. They were formerly known as prostitutes pupils because of their association with syphilis and because of the convenient mnemonic that, like a prostitute. Argyll robertson pupil argyll robertson described his pupillary syndrome in 1869. Significance of the argyll robertson pupil in clinical medicine the. Since then, he complained of diplopia on both up and down gaze. Ogilvie departments of ophthalmology and pathology, permanente medical group.
Department of ophthalmology, university of iowa hospitals, iowa city, iowa, usa. The observation which made argyll robertson s name famous was published in two articles. The argyll robertson pupil soon became a pathognomonic sign in tabes dorsalis, dementia paralytica, and. Argyll robertson pupil jama ophthalmology jama network. The argyll robertson pupil journal of neurology, neurosurgery. Argyll robertson pupils ar pupils are bilateral small pupils that constrict when the patient focuses on a near object they accommodate, but do not constrict when exposed to bright light they do not react to light. Robertson was president of the royal college of surgeons of edinburgh for 18867. Argyll robertson pupil aberrant regeneration third nerve injury misdirection. Argyll robertson pupil is ascribed to a lesion of intercalated neurons in the midbrain or to damage of inhibitory fibers to the oculomotor nucleus loewenfeld.
The argyll robertson ar pupil has been defined as a pupil that is small and constricts poorly to direct light but briskly when a target. He was treated with phenytoin but defaulted subsequent followup. Dr douglas moray cooper lamb argyll robertson frse, frcsed lld 1837 3 january 1909 was a scottish ophthalmologist and surgeon. Argyll robertson pupil pathophysiology, causes, symptoms, types. Argyll robertson pupil one that is miotic and responds to accommodation effort, but not to light. Argyll robertson pupil definition of argyll robertson pupil. Argyll robertson pupils ar pupils are bilateral small pupils that reduce in size on a near object i. Lymphocytic meningoradiculitis or bannwarths syndrome is clinically characterised by severe radicular pains with sensory and motor impairment and cranial nerve palsies, especially unilateral or bilateral facial weakness. The cataract condition can also be detected if the pupil is either cloudy or pale in colour. Argyll robertson pupil is usually bilateral and presents as bilaterally miotic and irregular pupils, which constrict briskly with accommodation but do not react to bright light therefore displaying lightnear dissociation 1 it is a highly specific sign of late neurosyphilis, however can also occur in diabetic neuropathy, multiple sclerosis, alcoholic midbrain degeneration, and stroke 2,3. Argyll robertson pupil is usually bilateral and presents as bilaterally miotic and irregular pupils, which constrict briskly with accommodation but do not react to. He introduced physostigmine into ophthalmic practice and the argyll robertson pupil is named after him. Inverse argyll robertson pupil iarp, absence of pupillary constriction to near stimuli with retention of pupillary light re.
Argyll robertson pupil definition of argyll robertson. A case of congenital oculomotor paralysis demonstrating retraction of the upper lid and constriction of the pupil in response to eye movements is described. Mar, 2021 argyll robertson ar pupils, are characterized by small and irregular pupils that have little to no constriction to light but constricts briskly to near targets lightnear dissociation. Robertson noted the association between the pupillary syndrome and disease of the spinal cord. In 1869 douglas moray cooper lamb argyll robertson described his famous pupillary sign in two papers. Argyll robertson pupil project gutenberg selfpublishing. Argyll robertson pupil an overview sciencedirect topics. He sustained closed head injury with a right third nerve palsy. Among 54 cases of partial paralysis of the pupil of unknown aetiology, gordon holmes found 19 in which the paralysis of the pupil was associated witlh signs of other. He was the first captain of the royal colleges golf club and presented to it a handsome scratch medal, which is known by his name and is awarded annually for the best.
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