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Argyll Robertson pupils (“AR pupils" or colloquially "prostitute's pupils") are bilateral small pupils that reduce in size on a near object (they “accommodate”), but do ''not'' constrict when exposed to bright light (they do not “react” to light). They are a highly specific sign of neurosyphilis, and might also be a sign of diabetic neuropathy. In general, pupils that “accommodate but do not react” are said to show light-near dissociation- i.e., it is the absence of a miotic reaction to light, both direct and consensual, with the preservation of a miotic reaction to near stimulus (accommodation-convergence). A video of AR pupils and light-near dissociation is available (here ) AR pupils are extremely uncommon in the developed world. There is continued interest in the underlying pathophysiology, but the scarcity of cases makes ongoing research difficult. ==History== The term Argyll Robertson pupils was named after Douglas Argyll Robertson (1837–1909), a Scottish ophthalmologist and surgeon, who described the condition in the mid 1860s in the context of neurosyphilis. In the early 20th century, William John Adie described a second type of pupil that could “accommodate but not react.” Adie’s tonic pupil is usually associated with a benign peripheral neuropathy (Adie syndrome), not with syphilis.〔Kawasaki A. Physiology, assessment, and disorders of the pupil. Curr Opin Ophthalmol 10(6):394-400, 1999〕 When penicillin became widely available in the 1940s, the prevalence of AR pupils (which develop only after decades of untreated infection) decreased dramatically. AR pupils are now quite rare. A patient whose pupil “accommodates but does not react” almost always has a tonic pupil, not an AR pupil. In the 1950s, Loewenfeld〔Thompson HS, Kardon RH. Irene E. Loewenfeld, PhD Physiologist of the Pupil. J Neuroophthalmol 26(2):139-148, 2006〕 distinguished between the two types of pupils by carefully observing the exact way in which the pupils constrict with near vision. The near response in ''AR pupils'' is brisk and immediate. The near response in ''tonic pupils'' is slow and prolonged. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Argyll Robertson pupil」の詳細全文を読む スポンサード リンク
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