This uncommon syndrome involves vertical gaze palsy associated with pupils that “accommodate but do not react." The causes of Parinaud syndrome include brain tumors (pinealomas), multiple sclerosis and brainstem infarction. Due to the lack of detail in the older literature and the scarcity of AR pupils at the present time, it is not known whether syphilis can cause Parinaud syndrome. It is not known whether AR pupils are any different from the pupils seen in other dorsal midbrain lesions. The condition is diagnosed clinically by a physician. Treatment
There is no definite treatment, but, because syphilis may be an underlying cause, it should be treated. However, because this sign is associated with neurosyphilis, it should be treated with crystalline penicillin 24 mU intravenous per day for 10 to 14 days. If the patient is allergic to penicillin, they should undergo desensitization and then be treated. History
Argyll Robertson pupils were named after Douglas Argyll Robertson (1837–1909), a Scottish ophthalmologist and surgeon who described the condition in the mid-1860s in the context of neurosyphilis. In the early 20th century, William John Adie described a second type of pupil that could "accommodate but not react". Adies tonic pupil is usually associated with a benign peripheral neuropathy (Adie syndrome), not with syphilis.When penicillin became widely available in the 1940s, the prevalence of AR pupils (which develop only after decades of untreated infection) decreased dramatically. AR pupils are now quite rare. A patient whose pupil “accommodates but does not react” almost always has a tonic pupil, not an AR pupil.
In ophthalmology, accommodative excess (also known as excessive accommodation or accommodation excess) occurs when an individual uses more than normal accommodation (focusing on close objects) for performing certain near work. Accommodative excess has traditionally been defined as accommodation that is persistently higher than expected for the patients age. Modern definitions simply regard it as an inability to relax accommodation readily. Excessive accommodation is seen in association with excessive convergence also. Symptoms and signs
Blurring of vision due to pseudomyopia
Headache
Eye strain
Asthenopia
Trouble concentrating when reading

Causes
Causes related to refractive errors
Accommodative excess may be seen in the following conditions:
Hypermetropia: Young hypermetropes use excessive accommodation as a physiological adaptation in the interest of clear vision. Myopia: Young myopes performing excessive near work may also use excessive accommodation in association with excessive convergence. Astigmatism: Astigmatic eye may also be associated with accommodative excess. Presbyopia: Early presbyopic eye may also induce excessive accommodation. Improper or ill fitting spectacles: Use of improper or ill fitting spectacles may also cause use of excessive accommodation. Causes related to systemic drugs
Use of systemic drugs like Morphine, Digitalis, Sulfonamides, Carbonic anhydrase inhibitors may cause accommodative excess. Causes related to diseases
Unilateral excessive accommodation-Trigeminal neuralgia, and head trauma may cause ciliary spasm and may cause accommodative excess. Bilateral excessive accommodation-Diseases like Encephalitis, Syphilis, Head trauma, Influenza, Meningitis may cause ciliary spasm and bilateral excessive accommodation. Secondary to Convergence insufficiency
Accommodative excess may occur secondary to convergence insufficiency also. In convergence insufficiency near point of convergence will recede, and positive fusional vergence (PFV) will reduce.