A 45 year old male had history of unprotected sexual intercourse 15 year back, what is the pupil condition in this patient?
(B) Accommodation reflection positive...[?]As a questions shows unprotected sexual intercourse 15 years back in a 45 year old male suggestive of a patient suffered syphilitic disease & developing presently with Tabes Dorsalis with Argyll-Robertson Pupil.ARGYLL-ROBERTSON PUPILArgyll Robertson Pupil is usually caused by lesion, almost invariably syphilitic in origin.It is characterised by absence reaction to light, but Accommodation Reflex Present in a miotic pupil.Mnemonic: ARP stands for Argyll Robertson Pupil, i.e., Accommodation Reflex PresentClinical features:Pupil <3mm in diameterIrregular, unequal, miotic pupilNearly always bilateralTotal absence of reaction to lightReaction to convergence & accommodation presentPoor response to pain & mydriaticAbsent ilio-spinal responseAtrophic patches & depigmentation of irisNormal media & optic nerveLesion:Not known.Most probable site may be mid brainAetiology: (pathognomonic of Tabes dorsalis)Neurosyphilis (Tabes dorsalis, G.P.I. & Meningo-vascular syphilis)DiabetesChronic alcoholismEpidemic encephalitisMultiple sclerosisCNS degenerative diseasesTumours of mid brainSyringomyeliaHerpes zoster ophthalmicusChronic hypertrophic polyneuritisTrauma behind the eyeVARIOUS TYPES OF OPHTHALMIC PUPILSInverse-Argyll Robertson Pupil:*. Clinical features:*. Reflex to light is retained*. Loss of pupillary reflex to accommodation & convergence.*. Site of lesion: Mid-brain (connection between nucleus of Perlia & Edinger-Westphal nucleus).*. Aetiology:*. Diphtheria*. Corpora quadrigeminal tumoursTonic Pupil (Adie's Pupil):Adie's pupil... inability of pupil to respond to light on near stimuli, usually unilateral & occurs in young women.*. Clinical features:*. F>M, Usually in 3rd decade*. Frequently young adult woman*. 80% unilateral, moderately dilated*. Delayed or diminished direct & consensual reaction to the light*. May be associated with loss of tendor reflexes (Adie's syndrome).*. Reaction to mydriatics & miotics are normal*. Once developed is permanent*. Site of lesion: Damage to ciliary ganglior & aberrant regeneration of nerve flow.*. Test: A weak 0.25% Pilocarpine instillation causes tonic pupil to constrict but not normal pupil.*. Aetiology: Obscure but not syphilis.Hutchinson's Pupil:*. Clinical features:*. Develops after head injury*. Widely dilated immobile pupil on the same side*. Loss of both direct & consensual reflexes to tight.*. Site of lesion: Stretching of 3rd nerve on the same side.*. Aetiology: Diagnostic of fracture skull with meningeal haemorrhage.Horner's Syndrome:*. Clinical features:*. Unilateral miosis*. Ptosis*. Enophthalmos*. Absence of sweating on the ipsi-lateral face & neck*. Site of lesion:*. Sympathetic pathway in the brainstem*. Upper spinal cord*. Peripheral sympathetic chain*. Aetiology:*. Cervical vertebral fracture*. Tabes dorsalis*. Syringomyelia*. Cervical cord tumour*. Apical tuberculosis*. Apical bronchogenic carcinoma*. Mediastinal tumour*. Aneurysm of carotid or subclavian artery*. Cervical lymphadenopathyHippus:*. Clinical features:*. Alternate rhythmic dilatation and constriction of pupils*. Associated with respiratory rhythm*. Site of lesion:*. Imbalance of sympathetic & parasympathetic division of ANS*. Aetiology:*. Recovery of III nerve palsy*. Disseminated sclerosis*. Syphilis*. NeoplasmsMarcus Gunn pupil:*. Normal sized pupil, both the direct & consensual reaction are present, Relative Afferent Pupillary Defect (RAPD) on swinging light test, (caused by optic nerve or severe retinal disease).
Accommodation reflection negative, and Pupillary reaction positive
Accommodation reflection positive, and Pupillary reaction negative
Accommodation reflection positive, and Pupillary reaction positive
Accommodation reflection negative, and Pupillary reaction negative
Strabismus