Treatment of Bilateral Tonic Pupil Associated with Syphilis.

Mun, Yong Seok; Yang, Hee Kyung; Hwang, Jeong Min

doi:2018.59.7.697

J Korean Ophthalmol Soc > Volume 59(7); 2018 > Article

Case Report

Journal of the Korean Ophthalmological Society 2018;59(7):697-701.
DOI: https://doi.org/10.3341/jkos.2018.59.7.697 Published online July 15, 2018.

Treatment of Bilateral Tonic Pupil Associated with Syphilis.

Yong Seok Mun, Hee Kyung Yang, Jeong Min Hwang

Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. eye@snubh.org

매독에 동반된 양안 긴장동공의 치료

문용석⋅양희경⋅황정민

서울대학교 의과대학 분당서울대학교병원 안과학교실

Correspondence: Hee Kyung Yang,
Email: eye@snubh.org

Received: 23 March 2018 • Revised: 30 April 2018 • Accepted: 21 June 2018

Abstract

PURPOSE
We report a case of a male with bilateral tonic pupils associated with syphilis, that partially improved after syphilis treatment. CASE SUMMARY: A 27-year-old male presented with a 2-month history of near vision impairment. The right and left pupils were 5.5 mm and 6.5 mm in diameter, respectively, in the dark and 5.3 mm and 6.1 mm, respectively, in the light. Both pupils demonstrated light-near dissociation, slow constriction and redilation when looking at near, and constriction after instillation of 0.0625% pilocarpine. Serological tests were positive for syphilis, while cerebrospinal fluid testing was negative. Two months after treatment with intramuscular injection of benzathine penicillin G, his near vision subjectively improved and the right and left pupils were 5.9 mm and 6.4 mm, respectively, in the dark and 4.8 mm and 5.3 mm, respectively, in the light. The size of both pupils decreased and the pupillary light responses partially improved in both eyes. CONCLUSIONS: Patients with bilateral tonic pupils should have serological tests for syphilis. Recovery of tonic pupils can be expected after early treatment with effective antibiotics.

Key Words: Syphilis;Tonic pupil