What are the other Names for this Condition? (Also known as/Synonyms)

• AR Pupils

What is Argyll Robertson Pupils? (Definition/Background Information)

• Argyll Robertson Pupils are eye examination findings wherein small pupils are seen that do not constrict in size when exposed to bright light. The constriction is seen when the individual focuses on a nearby object. This bilateral condition is specific to late-stage syphilis
• Syphilis is a very common infectious disease caused by the bacterium Treponema pallidum. Syphilis is generally transmitted through sexual contact. Late-stage syphilis (or tertiary syphilis) is a severe form of syphilis showing an involvement of several vital organs such as the heart, eye, liver, and the central nervous system
• There is no specific treatment for Argyll Robertson Pupils; a treatment of the underlying syphilis is important. The overall prognosis is dependent on the extent of syphilis and the involvement of other body organs. In many cases, the prognosis of advanced stage syphilis is unfavorable

Who gets Argyll Robertson Pupils? (Age and Sex Distribution)

• Argyll Robertson Pupils is a rare complication of neurosyphilis (advanced form of syphilis where the nervous system is affected)
• The condition is typically observed in adults
• Both males and females may be affected
• Worldwide, individuals of all racial and ethnic groups may be affected

What are the Risk Factors for Argyll Robertson Pupils? (Predisposing Factors)

• The single most important risk factor for Argyll Robertson Pupils is a lack of diagnosis and/or treatment of syphilis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Argyll Robertson Pupils? (Etiology)

The exact mechanism of development of Argyll Robertson Pupils is unknown.

• Some researchers believe that infection due to neurosyphilis may result in nerve dysfunction causing the condition
• Argyll Robertson Pupils may develop after several years to decades following first onset of syphilitic infection

What are the Signs and Symptoms of Argyll Robertson Pupils?

The signs and symptoms of Argyll Robertson Pupils may include:

• Lack of or sluggish response to light for pupillary constriction
• When pupils are dilated using atropine, the duration of dilatation may be prolonged
• Associated atrophic iris may be noted
• Both the eyes are typically involved

Other signs and symptoms of neurosyphilis (late stage of syphilis) may be noted such as:

• Involvement and progressive degeneration of the tissues of the brain and spinal cord 
• Muscular function impairment
• Severe gastrointestinal/excretory system crisis
• Problems with gait, walking, and bone joint degeneration
• Abnormal increase in touch and feel sensitivity (sensory stimulations)
• Mental health disorders

How is Argyll Robertson Pupils Diagnosed?

Argyll Robertson Pupils may be diagnosed by the following observations and tests:

• Physical examination and medical history evaluation
• Assessment of signs and symptoms
• General eye exam
• Fundoscopic (ophthalmoscopic) examination by an eye specialist, who examines the back part of the eye (or the fundus)
• Visual acuity test using a special and standardized test chart (Snellen chart)
• Slit-lamp examination
• Gonioscopy, a painless eye exam using special devices
• Visual evoked potential (VEP) test

Tests and procedures to diagnose underlying syphilis, if necessary, may include:

• Exam of cerebrospinal fluid via a lumbar puncture
• Blood tests for detecting antibodies against syphilis
• CT scan of cranium
• Cerebral angiogram
• MRI scan of brain and spinal cord

A differential diagnosis to eliminate other conditions may be considered, before arriving at a definitive diagnosis. These may include:

• Aberrant regeneration of the third nerve
• Adie’s tonic pupil
• Chronic alcoholism
• Encephalitis
• Herpes zoster infection
• Lyme disease
• Miller-Fisher variant of acute idiopathic demyelinating polyradiculopathy
• Multiple sclerosis
• Neurosarcoidosis
• Optic nerve disease
• Parinaud syndrome
• Peripheral neuropathies due to diabetes
• Pretectal syndrome
• Sylvian aqueduct syndrome

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Argyll Robertson Pupils?

Argyll Robertson Pupils develops as a complication of neurosyphilis, which is the advanced stage of syphilis. Neurosyphilis is associated with severe complications such as:

• Blindness
• Many vital organs of the body to be severely affected
• Severely impaired memory; progressive degeneration of mental health
• Significant and irreparable damage of the spinal column and nervous system

How is Argyll Robertson Pupils Treated?

• There is no cure for Argyll Robertson Pupils; suitable treatment should be considered for underlying syphilis
• All manifestations and stages of syphilis are treated using the antibiotic drug penicillin

How can Argyll Robertson Pupils be Prevented?

The preventative measures for Argyll Robertson Pupils involves preventing the underlying causative syphilitic infection. The prevention measures for syphilis includes:

• Avoidance of multiple sex partners
• Practicing safe sex
• Avoiding excessive craving for drugs and alcohol which may lead to unsafe practices such as ‘sex for drugs’
• Undertaking regular screening for sexually transmitted diseases, especially for high-risk individuals

What is the Prognosis of Argyll Robertson Pupils? (Outcomes/Resolutions)

The presence of Argyll Robertson Pupils indicates neurosyphilis (late stage syphilis).

• Late management of syphilis typically results in damage to the central nervous system, bones, heart, lungs, and GI system that may be permanent
• The extent of the damage depends on a host of factors but is generally unfavorable

Additional and Relevant Useful Information for Argyll Robertson Pupils:

Please visit our Eye & Vision Health Center for more physician-approved health information:

https://www.dovemed.com/health-topics/vision-center/