The swinging flashlight test,otherwise known as the marcus gunn. The affected pupil shows an unchanged contraction before dilating. This is an important part of the neurological examination of the eye. To observe these examples, move the mouse pointer over the pupil or each eye as if it were a light pen. Bilateral sensory disorder such as maculopathy or atrophy of the optic nerve. Jun 06, 2014 rapd relative afferent pupillary defect rapd cause a reduction in pupil contraction when one eye is stimulated by light compared with when the opposite eye is stimulated by light. Mar 26, 2018 rapd, relative afferent pupillary defect, marcusgunn pupil neuroophthalmology with dr.
Afferent pupillary defect article about afferent pupillary. How to test for a relative afferent pupillary defect rapd article pdf available in community eye health international centre for eye health 257980. The afferent pupillary defect is a reduction in the response of the pupils to light stimulation of an eye with impaired vision, which is detected by comparing the defective response with that. A clinical evaluation of the pupillary response reveals valuable information about the integrity of the structures involved in the pupil reflex. Backgroundrelative afferent pupillary defects are typically related to ipsilateral lesions within the anterior visual pathways. Abnormalities in pupillary light reflex can indicate optic nerve disorders that may lead to permanent visual loss if not diagnosed in an early stage. In humans the eye is of the camera type, with an iris diaphragm and variable focusing, or accommodation. Relative afferent pupillary defect rapd or marcus gunn pupil shone on affected eye.
The direct and consensual pupillary responses to light are normal. This was likened to a case previously described by ellis. Westphal nuclei innervate the iris pupillary sphincter muscle. In these cases, assume that the testing is being done in a dimly illuminated room.
The arrows represent the light this is a common case in pupillary examination. Afferent pupillary defect apd or marcusgunn pupil is a condition of the eye where the pupil doesnt dilate appropriately to the level of light reaching it. Autonomic nervous system disturbances such as pupillary. An rapd is due to unilateral or asymmetrical disease of the retina or optic nerve. Marcus gunn pupil is also known as marcus gunn sign and relative afferent pupillary defect rapd. Provides very accurate measurement of pupil diameter for refractive surgery screening and planning lasik and iols under. Relative afferent pupillary defect relative afferent pupillary defect rapd is an asymmetry in the pupillary light response detection of rapd is performed by alternately illuminating each eye while comparing the velocity and amplitude of the pupillary responses. A relative afferent pupillary defect rapd is characterized by diminished pupillary constriction on direct illumination with a normal consensual response to illumination of the contralateral eye.
Quantifying relative afferent pupillary defects using a. Relative afferent pupillary defect rapd is a medical sign observed during the swingingflashlight test whereupon the patients pupils dilate when a bright light is swung from the unaffected eye to the affected eye. The relative afferent pupillary defect is the most common abnormal pupillary finding, more common than all other pupillary defects combined. The anatomy of the human pupillary light reflex plr pathway is a matter of debate. Rapd, relative afferent pupillary defect, marcusgunn. Pdf how to test for a relative afferent pupillary defect.
Only the swinging flashlight test uncovers the afferent abnormality in these patients i. The swinging light test shows abnormal light response of the. This left relative afferent pupillary defect rapd persisted throughout his hospitalization. Problems in the afferent half of the pupillary light reflex e. In the setting of claimed complete visual loss in 1 eye only, other evidence to support optic nerve dysfunction should be present. Brightness sensitivity and color perception as predictors of relative. Significantly, the left pupil was minimally reactive. A relative afferent pupillary defect rapd can be a worrisome exam finding, so an understanding of its possible etiologies is crucial. Rapd, relative afferent pupillary defect, marcusgunn pupil.
The affected pupil dilates to a larger size immediately. Relative afferent pupillary defect in glaucoma sciencedirect. This pupillary sign is characterized by the presence of a normal bilateral pupillary response when the normal eye is illuminated, but when the light is quickly moved to the abnormal side there is pupillary dilatation. We are fascinated by the material presented in the case report by forman et al. Background relative afferent pupillary defects are typically related to ipsilateral lesions within the anterior visual pathways objective to describe a patient who had a workup for headache and was found to have an isolated left relative afferent pupillary defect without any other neurological findings. The relative afferent pupillary defect rapd, is also called the marcus gunn pupil, after the ophthalmologist that described the defect in 1883. The relative afferent pupillary defect rapd tested by shining light into the eyes and checking their pupillary response can be useful for detecting unilateral or asymmetrical disease of the. Relative afferent pupillary defect ophthalight digital. The afferent pupillary defect apd or relative afferent pupillary defect rapd is an abnormal and unequal response in the pupils of the eyes when exposed to light. A short video demonstrating how to correctly examine a patients pupils to find a relative afferent pupil defect. A relative afferent pupillary defect without any visual sensory. In this case, the left eye shows an initial weak constriction followed by dilation to a larger size. Most often, patients have an ocular or medical history that might explain its presence.
The patient did not blink to threat on testing of his left eye. Clinical grading of relative afferent pupillary defects. Afferent pupillary defect definition of afferent pupillary. To investigate the relationship between relative afferent pupillary defect rapd and retinal nerve fiber layer rnfl thickness assessed by optical coherence. In this study, we focus on relative afferent pupillary defect rapd, which is based on the difference between the reactions of the eyes when they are exposed to light stimuli. Relative afferent pupillary defect, patients left eye. Describe parasympathetic and sympathetic pupillary pathway anatomy. An external file that holds a picture, illustration, etc.
An afferent pupillary defect apd, or marcus gunn pupil results from a lesion of the optic nerve e. Relative afferent pupillary defect in patients with asymmetric cataracts. How to test for a relative a erent pupillary defect rapd. Sixtyfive participants were recruited 32 with open. Afferent pupillary defect synonyms, afferent pupillary defect pronunciation, afferent pupillary defect translation, english dictionary definition of afferent pupillary defect. The relative afferent pupillary defect rapd, or marcusgunn pupil is an extremely significant and highly objective clinical finding in the examination of the visual system. This person with apd is often unaware of it except by looking in a mirror. How to test for a relative afferent pupillary defect rapd ncbi. Request pdf relative afferent pupillary defect in glaucoma.
Near dissociation, and a relative afferent pupillary defect without visual loss in. Relative afferent pupillary defect with normal visual. Rapd, relative afferent pupillary defect, marcusgunn pupil neuroophthalmology with dr. The sign causes much confusion, but in reality is a very simple sign.
Asymmetrical differences in retinal appearance or optic nerve. How to test for a relative afferent pupillary defect rapd. It may indicate dynamic anisocoria or a marcus gunn pupil, a relative afferent pupillary defect rapd, or temporal lobe herniation in the brain 1112. Marcus gunn in 1904, it is clear from his report that the sign was generally known to clinicians of his time. It is typically related to lesions within the anterior visual pathways. The presence of a relative afferent pupillary reflex rapd is one of the most important signs in neurophthalmology as it provides objective evidence of damage to the anterior visual pathways. Pdf the swinging light test is used to detect a relative afferent pupil defect rapd. Afferent pupillary defect an overview sciencedirect topics. Midbrain 3rd nerve nucleus parasympathetic efferent anatomy. Relative afferent pupillary defect rapd marked shining the light in the affected eye will result in no constriction of either pupil. Even in an unconscious patient, the determination of an rapd can be made. The pupillary light reflex regulates the amount of light reaching the retina. For example, if a patient with a retinal detachment in the left eye had had that pupil dilated so that the left pupil was 7 mm and the right 4 mm, and if the measured afferent pupil defect was 0.
Relative afferent pupillary defect rapd is a condition in which a persons pupils respond differently from one another to light stimuli shone, based on when it is shone into one eye at a time. Relative afferent pupillary defect interactive clinical examples. For example, a patient with a history of total retinal detachment in one eye would manifest a relative afferent pupillary. Despite the lack of any afferent visual deficit, there was a moderate rightsided relative afferent pupillary defect figure 1. Jul 05, 2017 marcus gunn pupil is also known as marcus gunn sign and relative afferent pupillary defect rapd. Other types of eye are the simple eye, found in many invertebrates, and the compound eye, found in insects and many other click the link for more information. Relative afferent pupillary defect rapd, marcus gunn pupil an rapd is a defect in the direct response. Relative afferent pupillary defect definition of relative. There are many different conditions which lead to this finding, from severe glaucoma to an optic. Apr 20, 2015 b bilateral afferent pupillary defect causes. If you have a disability and are having trouble accessing information on this website or need materials in an alternate format, contact web. The swinging light test shows abnormal light response of the affected eye initial dilatation followed by constriction. Louis, missouri case reports case 1this 56yearold black woman was origi nally seen in 1971 with splinter hemorrhages on both disks, slight elevation of intraocular pressure, and normal visual fields.
It is due to damage inoptic nerve or severe retinal disease. Relative afferent pupillary defect rapd assessment of rapd relative afferent pupillary defect for assessing the indirect response, utilize the swinging flashlight test by placing the penlight in front of the right eye od the examiner initially watches the right eye for a direct response and the left eye for a consensual response. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced. Relative afferent pupillary defect rapd is a condition in which pupils respond differently to light stimuli shone in one eye at a time due to unilateral or asymmetrical disease of the retina or optic nerve. The prevalence of relative afferent pupillary defects in normal subjects journal of neuro. This will often result in one pupil appearing larger than the other relative afferent pupillary defect rapd. The normal pupillary light reflex is symmetric when the righteye stimulus is compared with the lefteye stimulus.
The affected pupil shows a weak initial contraction before dilating to a larger size. A patient with optic neuritis affecting the left eye, and a normal right eye. To study the presence of relative afferent pupillary defect rapd in patients with glaucoma with the help of a custombuilt pupillometer. Neuroophthalmology of pupillary functionpractical guidelines. Rapd relative afferent pupillary defect pupillometer. An asymmetric pupillary light reflex or relative afferent pupillary defect rapd is a useful way to detect asymmetric retinal or optic nerve diseases. Marcus gunn pupil an overview sciencedirect topics. To characterize the relationship between brightness sensitivity and color perception and relative afferent pupillary defect rapd in patients with optic neuropathy. An overview how to examine pupillary function and handle pupillary abnormalities is presented. A pupillometric study to study the presence of relative afferent pupillary defect rapd in patients with glaucoma with the help of.
Correlation of relative afferent pupillary defect and retinal nerve. It is important to be able to differentiate whether a patient is complaining of decreased vision from an ocular problem such as cataract or from a defect of the optic nerve. The swinging light test is used to detect a relative afferent pupil defect rapd. Relative afferent pupillary defect screening through transfer learning. Relative afferent pupillary defect screening through transfer. Although the relative afferent pupillary defect was described by r. Relative afferent pupillary defect in eyes with retinal.
For example, if the left eye were abnormal, both pupils constrict when the light is shown into the right eye. Correlation of relative afferent pupillary defect and retinal nerve fiber layer loss in unilateral or asymmetric demyelinating optic neuropathy. This article seeks to outline the neural pathway underlying pupil constriction and provides a guide to assessing pupillary light reaction to detect a relative afferent pupillary defect. Relative afferent pupillary defect ophthalight digital solutions. Retinal nerve fiber layer loss in glaucoma patients with a relative. The presence of pupil abnormalities and iris modifications is cosmetically undesirable and may affect the quality of postoperative. Rapd may be associated with visual field or electroretinographic asymmetries between the two eyes. Records both the right and left pupil responses simultaneously to calculate the magnitude of the relative afferent pupillary defect in light log units.
The relative afferent pupillary defect rapd is an important objective sign of. A student under the direct supervision of a teacher or professor. During a swinging flashlight test, the right pupil constricted from 4 mm to 2 mm, while the left remained at 5 mm. In patients with crao, an eye exam show profoundly decreased visual acuity, and the swinging light test see use this mnemonic to ensure a comprehensive eye exam on page 348 will reveal a relative afferent pupillary defect rapd. The swinging light test is used to detect a relative. Detecting a relative afferent pupillary defect using the. Isolated relative afferent pupillary defect secondary to. Pdf how to test for a relative afferent pupillary defect rapd.
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