'Inverse Argyll Robertson pupil' or inverse light-near dissociation is
usually ascribed to central nervous system dysfunction. A patient wit
h botulism developed pupils reactive to light but poorly to near stimu
li six weeks following initial presentation with complete ophthalmople
gia. This suggests retrograde transport of botulinum toxin, and calls
to reconsider the role of the Edinger-Westphal nucleus as a common pre
ganglionic nucleus for pupillary neurons in the ciliary ganglion.