Argyll Robertson Pupil

Argyll Robertson pupils describe the physical exam finding of small bilateral pupils that do not constrict when exposed to bright light but do constrict when focused on a nearby object. This finding is highly specific to late-stage syphilis. Scottish ophthalmologist and surgeon Dr. Douglas Argyll Robertson first described Argyll Robertson pupils in the mid-1860s. However, the root cause remains unknown till today, and the light reflexes are visibly affected. The condition usually occurs with other features of tertiary syphilis, which is how it is diagnosed and treated. As the underlying etiology is an STI, syphilis is spread from contact with the bodily fluids of a person with syphilis, typically during sexual contact with a sore (chancre) or from a mother to a fetus. Less common routes of transmission exist as well. Since the prevalence of syphilis is still rising, clinicians from emergency, primary, and internal specialties may encounter the presentation. In the tertiary stage of syphilis, the risk of morbidity is high, and this pupillary finding should be taken seriously. The underlying cause, if correctly identified, is easily treatable with antibiotics. Some complications relating to cardiac or nerve damage may be irreversible.