Argyll Robertson瞳孔，从病因来讲，这个情况可能比较少，为什么？听听郝晓军老师的解读。
10.3 Argyll Robertson Pupils
第三节 Argyll Robertson瞳孔
Symptoms
【症状】
Usually asymptomatic.
从病因来讲，这个情况可能比较少
为什么？
等会儿看到病因时，大家就明白了
Signs
Critical. Small, irregular pupils that exhibit “light-near” dissociation (i.e., react poorly or not at all to light but constrict normally during convergence). By definition, vision must be intact.
【主要体征】 瞳孔缩小，形状不规则，光-近反射分离，即瞳孔光反射很弱或消失，但集合时瞳孔正常收缩。视力正常。
Other. The pupils dilate poorly in darkness. Almost always bilateral, although may be asymmetric.
【其他体征】 暗处瞳孔不易散大，双侧瞳孔大小可不对称，但几乎均为双侧发病。
单从瞳孔角度来说，特征是瞳孔不等，光-近反射分离
Differential Diagnosis of “Light-Near” Dissociation
【光-近反射分离的鉴别诊断】
Bilateral optic neuropathy or severe retinopathy: Reduced visual acuity with normal pupil size.
1.双侧视神经病变或严重的视网膜病变 视力下降，瞳孔大小正常。
• Adie (tonic) pupil: Unilateral or bilateral irregularly dilated pupil that constricts slowly and unevenly to light. Normal vision. See 10.4, Adie (Tonic) Pupil
2. Adie瞳孔(强直性瞳孔) 单侧或双侧瞳孔不规则散大，对光反应迟缓和双侧瞳孔不等，视力正常。参见本章第四节Adie瞳孔(强直性瞳孔)。
• Dorsal midbrain (Parinaud) syndrome: Bilateral, normal to large pupils. Accompanied by convergence retraction nystagmus and supranuclear upgaze palsy. See 10.4, Adie (Tonic) Pupil and “Convergence-retraction” in 10.21, Nystagmus.
3.中脑背侧综合征(Parinaud综合征) 双侧受累，瞳孔正常或变大，伴集合-退缩性眼球震颤及核上性向上凝视麻痹。参见本章第四节Adie瞳孔(强直性瞳孔)和第十九节眼球震颤的“辐揍式-退缩性”部分。
第六版的WILLS增加了两点：
4. Rarely caused by third nerve palsy with aberrant regeneration. See 10.6, Aberrant Regeneration of the Third Nerve.
5. Others: Diabetes, alcoholism, etc.
Etiology【病因】
• Tertiary syphilis.
三期梅毒。
梅毒，引起的眼部并发症不少
因此，发现瞳孔不等，瞳孔缩小，需要检查光-近反射
结果阳性时，要排除梅毒
我们没有说要“确诊梅毒”，因为这个名词，还是有点敏感的，需要维护患者个人面子，需要保护医生自己
Work-Up【检查】
1 Test the pupillary reaction to light and convergence：To test the reaction to convergence, patients are asked to look first at a distant target and then at their own finger, which the examiner holds in front of them and slowly brings in toward their face.
1.检查瞳孔对光反应和集合反射 测试瞳孔的集合反射时，让患者先注视远方目标，然后注视患者自己的手指，检查者将患者手指保持在其前方，缓慢移向患者面部，观察瞳孔的变化。
2 Slit-lamp examination: Look for interstitial keratitis (see 4.18, Interstitial Keratitis).
2.裂隙灯检查 有无角膜基质炎。参见第四章第十八节角膜基质炎。
3 Dilated fundus examination: Search for chorioretinitis, papillitis, and uveitis.
3.散瞳查眼底 寻找有无脉络膜视网膜炎、视盘炎和葡萄膜炎。
梅毒，也可能引起这些眼部并发症
4 Fluorescent treponemal antibody absorbed (FTA-ABS) or microhemagglutination-Treponema pallidum (MHA-TP), rapid plasma reagin (RPR) or Venereal Disease Research Laboratories test (VDRL).
4.螺旋体抗体吸附荧光试验(FTA-ABS )或梅毒螺旋体微量血细胞凝集试验(MHA-TP)、快速血浆反应素试验(RPR)或性病实验室试验(VDRL)。
5 If the diagnosis of syphilis is established, lumbar puncture may be indicated. See 12.12, Syphilis, for specific indications.
5.如梅毒诊断成立，应考虑行腰椎穿刺脑脊液检查。检查方法参见第十二章第十二节梅毒。
Treatment【治疗】
1 Treatment based on presence of active disease and previous appropriate treatment.
1.根据病变是否活动及既往是否进行过正规治疗，决定治疗方案。
2 See 12.12, Syphilis, for treatment indications and specific antibiotic therapy.
2.治疗指征及特异性的抗生素治疗参见第十二章第十二节梅毒。
治疗，还是交给专科医生去完成吧
Follow-Up【随访】
This is not an emergency. Diagnostic work-up and determination of syphilitic activity should be undertaken within a few days.
本病非急症，但诊断性检查及明确梅毒是否具有活动性应在发现Argyll Robertson瞳孔数天内完成。