![]() ![]() Use an evenly bright source of illumination for examining the light reflexes. The patient must look at a distant target in order to prevent accommodation associated miosis that can confound your pupil exam.Įxamination of pupil should be done in a room with dim illumination in order to avoid constriction caused by a brightly lit room. The pupils constrict when the eyes focus at near. Sit to the side to avoid obstructing the patient’s view when you ask the patient to fixate at a distant target.Īsk the patient to maintain fixation on a distant target. Performing the exam Tip 1: Seating PositionĪsk the patient to sit comfortably on a chair while you sit on one side of the patient & never directly in front of the patient. These are pupils that do not constrict to light but will bilaterally accomodate with the near response. One or both eyes are abnormally dilated due to loss of parasympathetic innervation to the iris sphincter and ciliary muscle.Ĭolloquially known as “prostitute’s pupils”. A classic trick question is whether or not a dense white cataract can cause an RAPD – it won’t! ![]() Usually occurs as a result of optic nerve pathology or severe retinal disease. Relative Afferent Pupillary Defect (RAPD)/Marcus Gunn Pupil Note the right pupil is enlarged and the right eye is deviated outwards and downwards. The abnormal pupil in this syndrome is the smaller, left pupil. Note this patient has an abnormal iris as well likely secondary to surgical trauma.īrunescent Cataract. Posterior synechiae (adhesions between the iris and the lens capsule). Note how the iris is slightly more dilated at 2-3 o’clock. Incarceration of iris or vitreous in a surgical woundĪdies sectoral dilation. Written with Tanya Balakrishnan from Aravind Eye Hospital 5 key features: 1) Size ![]()
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