Related Experiment Video
Updated: Sep 23, 2026

System for Focal, Closed-System Central Nervous System Injury
Published on: November 29, 2024
Bilateral tonic pupils associated with neurosyphilis
Tsutomu Sakai1, Keigo Shikishima, Tokihide Mizobuchi
1Department of Ophthalmology, Jikei University School of Medicine, Tokyo, Japan.
Background:
To describe 4 patients with bilateral tonic pupils in neurosyphilis.
Cases:
Four young men had pupillary abnormalities, which involved irregular shapes, large sizes, tonic reactions, and vermiform movements of both pupils with light-near dissociation. Cholinergic supersensitivity defined bilateral tonic pupils.
Observations:
Neurosyphilis was diagnosed in these patients on the basis of ocular and laboratory findings.
Conclusions:
Bilateral tonic pupils may be important as initial findings in neurosyphilis. We conclude that patients with bilateral tonic pupils should undergo serologic tests for syphilis.
Related Concept Videos
Botulism
Multiple Sclerosis l: Introduction
Neural Regulation
Sexually Transmitted Infections
Bacterial Meningitis I: Introduction
Photoreceptors and Visual Pathways

