Argyll Robertson Pupil

What are Argyll Robertson pupils?

Argyll Robertson pupil, also called Argyll Robertson syndrome, refers to small pupils that get smaller (constrict) correctly when focusing on a near object, but not when they’re exposed to bright light.

Your pupil is the black circle in the middle of your iris, the colored part of your eye.

The condition is named after Douglas Argyll Robertson, a Scottish ophthalmologist, in the mid-to-late 19th century. Argyll is pronounced AR-gile, like argyle socks.

How can your healthcare provider tell if you have Argyll Robertson pupil?

Your eye care provider can tell if you have Argyll Robertson pupil during their examination of your eyes. Argyll Robertson pupil happens in both eyes (bilateral). They’re small and may be irregular.

When your pupils get smaller in response to light, it’s called the pupillary light reflex.

When your pupils get smaller to be able to focus on something close to your face, it’s called the accommodation reflex.

If your pupils don’t respond the way they’re supposed to in terms of light or in terms of nearby objects, it’s called a light-near dissociation.

What are the most common causes of Argyll Robertson pupil?

Argyll Robertson pupil happens in late-stage syphilis. Syphilis is a sexually transmitted infection that progresses in stages if it’s not treated. Vision problems happen during the late stage. Syphilis can be fatal.

Although scientists aren’t sure why Argyll Robertson pupil happens, they believe it’s because syphilis causes issues in the part of your brain that controls the pupillary light reflex, while not affecting the part that controls the accommodation reflex.

Other diseases cause symptoms that look like Argyll Robertson pupil, too. These other conditions include:

• Alcohol use disorder: This condition refers to frequent or heavy alcohol use.
• Diabetes: With diabetes, your body can’t properly use glucose (sugar) in the food you eat to nourish your cells.
• Encephalitis: Encephalitis is an inflammation of the brain that can be serious.
• Multiple sclerosis (MS): MS is an autoimmune disease that destroys the myelin that protects the nerves in your spinal cord and brain.

How is Argyll Robertson pupil treated?

Treating Argyll Robertson pupil requires treating the underlying cause. However, Argyll Robertson pupil can get worse over time and can’t be cured. Even so, Argyll Robertson pupil usually doesn’t make your vision worse.

Depending on the underlying cause, treatment may include things that you can do at home.

Treating syphilis

If you have Argyll Robertson pupil, your provider will first suspect syphilis as a cause. If you have syphilis, you might also have trouble with coordination or might have a rash or severe pain. Your provider will ask about your medical and sexual history and order a blood test to see if a lab can detect the infection. They may also order a lumbar puncture (spinal tap).

If you do have syphilis, your provider will prescribe an antibiotic, usually penicillin. A healthcare provider will usually give you this antibiotic with a needle intravenously (IV).

If you don’t have syphilis, your provider will continue to ask questions about your lifestyle and medical history to find out what may be causing Argyll Robertson pupil.

Treating diabetes

Your provider will suggest managing your diabetes to keep your blood sugar levels low and stable. They may suggest that you:

• Follow a consistent meal pattern.
• Eat foods with fiber, lean protein, smart carbohydrate choices and lower amounts of fat, salt and sugar.
• Get regular physical activity.
• Take care of your feet and skin.
• Check your blood sugar levels.
• Take medications as recommended, if necessary.
• Get adequate rest.

Treating multiple sclerosis

Multiple sclerosis (MS) is a complex disease. Problems with vision can be an early symptom. Eventually, the disease can cause issues with walking and bowel and bladder control, as well as memory problems and difficulties with sex. There’s no cure for MS.

Medications focus on managing symptoms, but your provider may also suggest physical rehabilitation and counseling for mental health concerns. Tips for managing MS at home include:

• Eat healthy foods, which means avoiding processed food, added sugars, salts and unhealthy fats.
• Get enough rest.
• Manage stress.
• Quit smoking.
• Limit alcohol intake.

Treating alcohol use disorder

If you have alcohol use disorder, your provider may suggest a combination of treatments that include medication, behavioral therapy and support groups.

How can Argyll Robertson pupils be prevented?

There’s no way to prevent Argyll Robertson pupil from developing. But you may be able to reduce your risk of developing some of the diseases associated with the condition.

For instance, you can use safe sex practices to reduce your risk of getting syphilis. Always use a condom or dental dam during sex.

When should Argyll Robertson pupils be treated by a healthcare provider?

Your provider will probably be the person who notices that you have Argyll Robertson pupil. They’ll discover it as part of a physical exam.

It’s a good idea to meet with a primary care provider and get regular physical and eye exams.