By Haley Masterson
To remember the ocular symptoms of Argyll-Robinson Pupil, just take the first letter of each word – ARP – and read it forwards and backwards. Forwards, you have ARP – Accommodation Reflex Present. Backwards, you have PRA – Pupillary Reflex Absent.
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. Remember that “accommodation” refers to the ability of the eyes to focus on a near object. 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. However, the “pupillary reflex” refers to the ability of the eye to constrict when exposed to a bright stimulus, such as your pen light.
Both reflexes include pupillary constriction, and are therefore both mediated through the parasympathetic fibers of the ciliary ganglion. 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. The pre-synaptic cells of this limb lie in the Edinger-Westphal nucleus of CN III.
The term “Argyll-Robinson Pupil” refers to a specific defect as a consequence of tertiary syphilis. 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”. 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.
Bibliography
Bouissee, Valerie, and John B. Kerrison, eds. 6th ed. Vol. 1. Lippincott, Williams & Wilkins.
Rohkamm, Reinhard. Color Atlas of Neurology. Stuttgart: Thieme, 2004.
I believe the correct term is Argyll-Robertson Pupil … not Robinson ……………
Thanks for the comment. Argyll-Robinson and Argyll-Robertson are both terms that are in useage, sometimes even within the same article. I can’t find any specific difference spelled out, though I’ve noticed that “Robertson” seems to be reserved exclusively for the syndrome when due to syphilis, whereas “Robinson” is used in a more generalized sense when the syndrome could be due to other disorders (see “Case Files: Internal Medicine” or “Handbook of Clinical Psychology” by Gurd, et. al.) Interesting!
I find it much easier to remember that it is the “prostitute’s pupil.” Prostitutes are more likely to have tertiary syphilis, and, just like the prostitute, the pupil accommodates, but doesn’t react!
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Thank you for another excellent post. Where else could anyone get that kind of information in such a perfect way of writing? I’ve a presentation next week, and I am on the look for such info.
I think Robertson is most correct. I googled both and Robertson came out as more medically relevant than Robinson. Google consensus. I like the term that you laid out above in your blog post: light-near dissociation. Eponyms are for schmucks with photographic memories. (That said, I’m def. claiming the first medically relevant novelty I discover. Hypocratic Oath 😉 ).
I agree. Argyll-Robertson, it is! Not sure if Robinson’s in Harrison’s.
that is my mnemonic emailed to first aid team!
Why it is also called prostitute’s pupil?
Because they accommodate but don’t react. (haha)
Also you get it from Syphilis
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