39 Argyll Robertson pupil
Examination
• The pupils are small and irregular
• Accommodation reflex is intact (Fig. 39.1)
• There may be depigmentation of the iris
• Bilateral ptosis and marked overcompensation by frontalis muscle (in tabes doralis).
Proceed by telling the examiner that you would like to do the following:
• Examine for vibration and position sense
• Test for Romberg’s sign and deep tendon reflexes (decreased)
Remember that these pupils show little response to atropine, physostigmine or methacholine.
