Which ocular finding is associated with neurosyphilis?

Which ocular finding is associated with neurosyphilis?

• A. Horner syndrome
• B. Anisocoria
• C. Argyll Robertson pupil
• D. Marcus Gunn pupil

Answer: (C)

Argyll Robertson pupil is the classic ocular sign of neurosyphilis. These pupils are typically small and may be irregular, and they show light-near dissociation: they do not constrict when exposed to bright light, but they do constrict normally during accommodation for near vision. This pattern occurs because the syphilitic process affects the pupillary light reflex pathway in the midbrain (pretectal area) while sparing the accommodation pathway. Neurosyphilis, especially in its tabes dorsalis or general paresis forms, is the condition most associated with this sign. Other findings like Horner syndrome (which presents with ptosis and miosis with anhidrosis and has a different mechanism), anisocoria (unequal pupils without the specific light-near dissociation), or Marcus Gunn pupil (an afferent defect from optic nerve disease) do not exhibit this distinctive light-near dissociation seen in Argyll Robertson pupils.

Argyll Robertson pupil is the classic ocular sign of neurosyphilis. These pupils are typically small and may be irregular, and they show light-near dissociation: they do not constrict when exposed to bright light, but they do constrict normally during accommodation for near vision. This pattern occurs because the syphilitic process affects the pupillary light reflex pathway in the midbrain (pretectal area) while sparing the accommodation pathway. Neurosyphilis, especially in its tabes dorsalis or general paresis forms, is the condition most associated with this sign. Other findings like Horner syndrome (which presents with ptosis and miosis with anhidrosis and has a different mechanism), anisocoria (unequal pupils without the specific light-near dissociation), or Marcus Gunn pupil (an afferent defect from optic nerve disease) do not exhibit this distinctive light-near dissociation seen in Argyll Robertson pupils.