Argyll Robertson Pupil – Ophthalmology MCQ

False about Argyll Robertson Pupil is?
A. Accommodation reflex normal
B. Direct pupillary reflex absent
C. Indirect pupillary reflex normal
D. Visual acuity normal

Correct answer : C. Indirect pupillary reflex normal

Argyll Robertson Pupil (ARP)

  • It is characterised by bilateral constricted pupils.
  • Accommodation reflex (near reflex) is normal.
  • Pupillary reflex (light reflex) – both direct and indirect – are absent.
  • This feature is known as light – near dissociation.
  • ARP was first described in neurosyphilis by Douglas Moray Cooper Lamb Argyll Robertson, a Scottish Ophthalmologist.
  • It is also seen in other conditions like encephalitis, diabetic neuropathy, multiple sclerosis, stroke etc.

Site of lesion:

  • It occurs due to damage to fibers which travel from the pretectal part of midbrain to the Edinger Westphal nucleus.
  • The rostral fibers which are responsible for the light reflex are affected.
  • But the caudal fibers which facilitate the accommodation reflex are not affected.
  • Hence the light reflex is absent and accommodation reflex is present.

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One Comment
  1. Nirmal A J

    Also please remember that there is something called ‘Reverse Argyll Robertson pupil’ which was seen in a condition called Encephalitis Lethargica. Now a days this is not seen. Hence if ‘Post encephalitic Parkinsonism’ is there among the options, it will be the answer.