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. Impaired light reaction in the setting of a normal near reaction may suggest an Adie tonic pupil or Argyll Robertson pupils of. Accommodation to near stimuli should also be examined (ie, to evaluate for light-near dissociation). 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 pupils should be evaluated for direct and consensual responses that are normally equal in speed and magnitude. 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. Asymmetry, impaired light responses, and preserved response to accommodation (light-near dissociation or Argyll Robertson pupil). Adie tonic pupil: light-near dissociation due to postganglionic parasympathetic pupillomotor damage Holmes Adie syndrome: Adie tonic pupil accompanied by photophobia, diminished deep tendon reflexes, and. 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. Light-near dissociation: a sluggish reaction of the pupil to light with accommodation intact 4 Unilateral light-near dissociation. 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. 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. ![]() ![]() Backwards, you have PRA – Pupillary Reflex Absent. 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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