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Argyll-Robertson Pupil and Neurosyphilis

Key Words: Argyll-Robertson pupil

TO THE EDITOR: I read Dr. Hutto's article¹ on syphilis with great interest and found it to be comprehensive and clinically useful. However, I do wish to take issue with one statement that is often repeated and commonly believed, namely that the Argyll-Robertson pupil is pathognomonic of neurosyphilis. Actually, this particular pupillary abnormality can occasionally be encountered in other conditions. For example, French's² notes that Argyll-Robertson pupils "occur most often in neurosyphilis but sometimes also in diabetes." Diabetes can cause an autonomic neuropathy affecting the pupil just as does syphilis, albeit much less often.

REFERENCES

1. Hutto B: Syphilis in clinical psychiatry: a review. Psychosomatics 2001; 42:453-460[Abstract/Free Full Text]
2. Bouchier IAD, Ellis H, Fleming PR (eds): French's Index of Differential Diagnosis, 13th edition. Oxford, Butterworth-Heineman, 1996

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