• In general, pupils that accommodate but do not react are said to show light-near dissociation (i.e., it is the absence of a miotic reaction to light, both direct and consensual, with the preservation of a miotic reaction to near stimulus (accommodation/convergence). (wikipedia.org)
  • This uncommon syndrome involves vertical gaze palsy associated with pupils that "accommodate but do not react. (wikipedia.org)
  • They were formerly known as "prostitute's pupils" because of their association with syphilis and because, like a prostitute, they "accommodate but do not react. (wikidoc.org)
  • Pupils that "accommodate but do not react" are said to show light-near dissociation . (wikidoc.org)
  • Argyll Robertson pupils (AR pupils) are bilateral small pupils that reduce in size on a near object (i.e., they accommodate), but do not constrict when exposed to bright light (i.e., they do not react). (wikipedia.org)
  • In the 1950s, Loewenfeld distinguished between the two types of pupils by carefully observing the exact way in which the pupils constrict with near vision. (wikipedia.org)
  • These light-sensitive pathways allow the pupil to constrict to bright light. (wikidoc.org)
  • The accommodation pathways - pathways to the Edinger-Westphal nucleus that cause the pupils to constrict with near vision - are thought to be spared because of their more ventral course in the brainstem. (wikidoc.org)
  • Often, the larger pupil is unable to constrict normally. (merckmanuals.com)
  • After short-term clonic-tonic convulsions, the muscles relax, tendon reflexes disappear. (abrogard.com)
  • Adie's tonic pupil is usually associated with a benign peripheral neuropathy (Adie syndrome), not with syphilis. (wikipedia.org)
  • Adie syndrome Anisocoria Cycloplegia Marcus Gunn pupil Miosis Neurosyphilis Parinaud's syndrome Syphilis Digre, Kathleen A. (1986). (wikipedia.org)
  • An ocular syndrome marked by Adie pupil and absent or lessened Achilles tendon reflex and knee-jerk reflex. (unboundmedicine.com)
  • The exact relationship between syphilis and the two types of pupils (AR pupils and tonic pupils) is not known at the present time. (wikipedia.org)
  • It is not known whether neurosyphilis itself (infection by Treponema pallidum) can cause tonic pupils, or whether tonic pupils in syphilis simply reflect a coexisting peripheral neuropathy. (wikipedia.org)
  • Due to the lack of detail in the older literature and the scarcity of AR pupils at the present time, it is not known whether syphilis can cause Parinaud syndrome. (wikipedia.org)
  • The AR pupil was named after Douglas Moray Cooper Lamb Argyll Robertson , a Scottish ophthalmologist who noted the association with syphilis in 1869. (wikidoc.org)
  • [2] When serological tests for syphilis became available, patients with AR pupils usually tested positive for syphilis. (wikidoc.org)
  • The AR pupil became known as a reliable clinical sign of syphilis. (wikidoc.org)
  • Adie's pupil is caused by damage to peripheral pathways to the pupil (parasympathetic neurons in the ciliary ganglion that cause pupillary constriction to bright light and with near vision). (wikipedia.org)
  • The AR pupil is thought to be caused by damage to central pathways for pupillary constriction. (wikidoc.org)
  • Specifically, the AR pupil is thought to be caused by selective damage to pathways from the retina to the Edinger-Westphal nucleus . (wikidoc.org)
  • These pathways carry nerve impulses to the pupil and to the muscles that control the eye and eyelid. (merckmanuals.com)
  • The pathophysiologic mechanism which produces an Argyll Robertson pupil is unclear, but is believed to be the result of bilateral damage to the pretectal nuclei in the midbrain. (wikipedia.org)
  • To settle the question of whether the AR pupil is of central or peripheral origin, it will be necessary to perform iris transillumination (or a magnified slit-lamp examination) in a substantial number of patients who have a pupillary light-near dissociation (with and without tonicity of the near reaction), perhaps in many parts of the world. (wikipedia.org)
  • A third cause of light-near dissociation is Parinaud syndrome, also called dorsal midbrain syndrome. (wikipedia.org)
  • In such people, both pupils react normally to light and darkness and there are no symptoms. (merckmanuals.com)
  • Thompson and Kardon summarize the present view: The evidence supports a midbrain cause of the AR pupil, provided one follows Loewenfeld's definition of the AR pupil as small pupils that react very poorly to light and yet seem to retain a normal pupillary near response that is definitely not tonic. (wikipedia.org)
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  • Horner Syndrome Horner syndrome affects one side of the face, causing the eyelid to droop, the pupil to become small (constricted), and sweating to decrease. (merckmanuals.com)
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  • Thus, people with nervous system disorders that affect the pupil often also have a drooping eyelid, double vision, and/or visibly misaligned eyes. (merckmanuals.com)
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  • however, Argyll Robertson pupils may also be a sign of diabetic neuropathy. (wikipedia.org)
  • Pinpoint pupils are a sign of opioid overdose but are not pathognomonic (e.g., pontine lesions of hemorrhagic or ischemic origins may produce similar findings). (clustermed.info)
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  • These more noticeable symptoms are often the reason people seek medical care rather than the unequal pupils. (merckmanuals.com)
  • AR pupils are extremely uncommon in the developed world. (wikipedia.org)
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  • Argyll Robertson pupils were named after Douglas Argyll Robertson (1837-1909), a Scottish ophthalmologist and surgeon who described the condition in the mid-1860s in the context of neurosyphilis. (wikipedia.org)
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  • Sometimes an iritis occurs from the traumatic event causing significant pain and light-sensitivity. (focusoptometry2020.com)
  • We report a case of 42 year old female patient with diffuse headache for 2 weeks, multiple episodes of generalized tonic clonic seizures and altered sensorium on the day of presentation to casualty without preceding history of fever, neck pain, visual loss or head trauma. (actascientific.com)
  • On hospital day three, he developed left-sided ptosis, ophthalmoplegia, and a mid-dilated fixed pupil. (bvsalud.org)
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