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Argyll robertson pupil tract1/23/2024 These include Adie’s tonic pupil and Parinaud Syndrome – and since the advent of penicillin, they are much more common in the Western world than Argyll-Robinson pupil.īouissee, Valerie, and John B. However, any lesion resulting in a present accommodation reflex and absent pupillary reflex can be referred to under the more general term “light-near dissociation”. The term “Argyll-Robinson Pupil” refers to a specific defect as a consequence of tertiary syphilis. The pre-synaptic cells of this limb lie in the Edinger-Westphal nucleus of CN III. Abnormal Pupil Differential Diagnoses Light Near Dissociation Anisocoria Worse in Light Anisocoria Worse in Darkness Adies Tonic Pupil Argyll Robertson. Remember that as long as a patient can sense light, the afferent limb of the pupillary constriction reflex should be intact – therefore, the absence of pupillary constriction in a seeing patient would indicate a defect in the efferent limb. However, the “pupillary reflex” refers to the ability of the eye to constrict when exposed to a bright stimulus, such as your pen light.īoth reflexes include pupillary constriction, and are therefore both mediated through the parasympathetic fibers of the ciliary ganglion. ARGYLL-ROBERTSON PUPILS Contrary to a reasonable expectation that the brain innervates eye muscles through short and direct pathways, the sympathetic tract. This reflex is carried out in part by pupillary constriction – so the pupils will constrict as you bring a far object into the near eye field – for example, moving your finger close to the patient’s nose. Remember that “accommodation” refers to the ability of the eyes to focus on a near object. Usually the constriction to light is stronger than constriction to a near stimulus, but the reverse is true in the case of Argyll-Robinson pupil. ![]() But, the difference between the Argyll Robertson pupil and the tonic pupil is the tonic pupil is tonic. However, where the direct reflex has been disrupted, the presence of a near reflex is important as part of the diagnosis of Argyll-Robertson pupil. ![]() Backwards, you have PRA – Pupillary Reflex Absent. tract to go to the pre-tectal nuclei in the dorsal. Forwards, you have ARP – Accommodation Reflex Present. To remember the ocular symptoms of Argyll-Robinson Pupil, just take the first letter of each word – ARP – and read it forwards and backwards.
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