Typically, there are 30 times the number of axons supplying the ciliary body compared to those for the iris. The parasympathetic fibers of the eye travel with the third cranial nerve to synapse at the ciliary ganglion before innervating the iris and the ciliary body. (Thompson 618) General Pathologyĭamage to the parasympathetic ciliary ganglion may result in a tonic pupil. While 80 percent of Adie tonic pupils are unilateral, bilateral involvement typically has an incidence of 4 percent per year. However, it may be noted that the tonic pupil was initially described in 1931 nearly synchronously by Adie, Morgan, Symonds, and Holmes in (2-4) EpidemiologyĪdie tonic pupil has a prevalence of population and occurs in a 2.6:1 female to male ratio with an average age of onset of 32 years (Thompson, 590). The entity is named after William John Adie, an Australian neurologist who extensively described the features.
#Argyll robertson pupil test full
Patients may also present with decreased deep tendon reflexes in the full Holmes-Adie Syndrome. Constriction is typically more notable with the near reaction and typically remains tonically constricted with slow re-dilation with segmental paralysis of the iris sphincter. The affected pupil, either unilateral or bilateral typically initially appears abnormally dilated at rest and has poor or sluggish pupillary constriction in bright light. Tonic Pupil ICD-10: H57.051 (right), H57.052 (left), H57.053 (bilateral)Īdie tonic pupil, known as Adie’s Syndrome or Holmes-Adie Syndrome, is a disorder in which there is parasympathetic denervation of the afflicted pupil resulting in a poor light but better and tonic near constriction. 2.4 Differential diagnosis and additional tests.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. 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 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. 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. 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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