Bilateral tonic pupils associated with neurosyphilis.

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.