Swinging flashlight test or marcus gunn test is one of the most basic eye exams that neurologists, ophthalmologists, optometrists and other physicians perform when visiting most of their. Pdf how to test for a relative afferent pupillary defect rapd. An rapd is due to unilateral or asymmetrical disease of the retina or optic nerve. I relative afferent pupillary defect marcus gunn pupil.
Evaluation of relative afferent pupillary defect using rapdx. This person with apd is often unaware of it except by looking in a mirror. 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. However, no previous report has used an objective technique to record the abnormal pupillary light reflex in such cases.
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. The near response is never affected andlightnear dissociation occurs. Methods seventynine consecutive subjects with manifest glaucomatous optic neuropathy at least in one eye were enrolled in this retrospective study. Purpose to identify the variable with the strongest association between the magnitude of the relative afferent pupillary defect rapd and visual field indices in patients with glaucomatous optic neuropathy. To study the presence of relative afferent pupillary defect rapd in patients with glaucoma with the help of a custom. Relative afferent pupillary defect with normal vision in a glial brainstem tumor. The test can be very useful for detecting unilateral or asymmetrical disease of the retina or optic nerve but only optic nerve disease that occurs in front of the optic chiasm. Read relative afferent pupillary defect, or afferent pupillary defect. Emergency atlas of afferent pupillary defect marcus gunn. Pupillographic evaluation of relative afferent pupillary.
Richmond eye associates, relative afferent pupillary defect. Afferent pupillary defect synonyms, afferent pupillary defect pronunciation, afferent pupillary defect translation, english dictionary definition of afferent pupillary defect. Relative afferent pupillary defect in glaucoma request pdf. Despite the lack of any afferent visual deficit, there was a moderate rightsided relative afferent pupillary defect figure 1. To identify clinical and pupillographic features of patients with a relative afferent pupillary defect rapd without visual acuity or visual field loss. Relative afferent pupillary defect rapd test in dim room with pt looking at the distance use bright source of light about 30cm from pts eyes swing light bw the eyes 23 sec on each eye make your decision within 23 swings. The prevalence of relative afferent pupillary defects in normal subjects journal of neuro. An absolute pupillary defect apd occurs when there has been severe damage to the optic nerve such that the eye is completely.
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. Relative afferent pupillary defect how to test for a. A normal response would be equal constriction of both pupils, regardless of which eye the light is directed at. With diminished afferent stimulation, less light is perceived, and pupil contraction diminishes ie, dilates as a result. 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. Its when the eyes pupil only slightly contracts or dilates when light shines over it. Characteristics of normal and abnormal pupilspart 2. Every effort should be made to make the experience as stressfree as possible. The marcus gunn pupil is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye.
Jul 25, 2007 a relative afferent pupillary defect rapd is an important sign of asymmetric or unilateral lesions of the anterior visual pathway. Clinical grading of relative afferent pupillary defects. Jul 05, 2017 marcus gunn pupil is also known as marcus gunn sign and relative afferent pupillary defect rapd. A patient with optic neuritis affecting the left eye, and a normal right eye. The swinging light test is used to detect a relative afferent pupil defect rapd. Further, we suggest a new strategy of lesion analysis by combining established techniques. Afferent pupillary defects do not cause anisocoria but they do cause abnormal light responses. Relative afferent pupillary defect medigoo health medical. Associating the magnitude of relative afferent pupillary. Even in an unconscious patient, the determination of an rapd can be made. Sep 15, 2008 published september 15, 2008 back to the basics, part 5. The usefulness of a new method of testing for a relative afferent pupillary defect in patients with ocular hypertension and glaucoma by dara lankaranian md, undraa altangerel md, george l. Twentyfive patients are reported, however, in whom an afferent pupillary defect occurred in the eye with better visual acuity.
Pdf the swinging light test is used to detect a relative afferent pupil defect rapd. For unselected patients, brightness comparison testing correctly predicted the rapd in 62% of patients. Relative afferent pupillary defect, or afferent pupillary. The relative afferent pupillary defect is the most common abnormal pupillary finding, more common than all other pupillary defects combined. Relative afferent pupillary defect in eyes with retinal. The swinging light test is used to detect a relative. If you continue browsing the site, you agree to the use of cookies on this website. It relies on a comparison between the two eyes, and is looking for and can only detect an asymmetrical abnormality in the afferent pathway. Rapd, relative afferent pupillary defect, marcusgunn pupil neuroophthalmology with dr. Marcus gunn in 1904, it is clear from his report that the sign. A relative afferent pupillary defect rapd is an important sign of asymmetric or unilateral lesions of the anterior visual pathway. Rapd can be observed in cases of asymmetrical retinal or optic nerve damage, including glaucomatous optic neuropathy. Marcus gunn pupil relative afferent pupillary defect. The anterior midbrain, controlling pupillary size, receives a message from the affected eye that illumination is reduced as compared with the fellow eye.
After consideration of various clinical investigations the significant factors identified. How to test for a relative afferent pupillary defect rapd david c broadway author information. Marcus gunn pupil is also known as marcus gunn sign and relative afferent pupillary defect rapd. How to test for a relative afferent pupillary defect rapd. Afferent pupillary defect an overview sciencedirect topics. 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. Pupillary findings associated with defects of the afferent arm of the pupillary light reflex arc. A relative afferent pupillary defect rapd generally indicates a unilateral or asymmetric disorder of the retina or optic nerve. Measurement of the relative afferent pupillary defect in. The anatomy of the human pupillary light reflex plr pathway is a matter of debate. In this case, the left eye shows an initial weak constriction followed by dilation to a larger size. Pdf how to test for a relative afferent pupillary defect.
For subgroups of patients with glaucoma and optic nerve. Evaluation of relative afferent pupillary defect using rapdx device in patients with optic nerve disease. A relative afferent pupillary defect can be an ominous exam finding. It is often the result of central or branch retinal or vein occlusion, extensive retinal detachment, retrobulbar optic neuritis, compressive optic neuropathy, or optic tract lesion, etc.
It is due to damage inoptic nerve or severe retinal disease. In general, the eye with poorer visual acuity has the afferent pupillary defect. How to test for a relative afferent pupillary defect. Relative afferent pupillary defect description, causes and risk factors. Apr 05, 2008 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. Relative afferent pupillary defect, patients left eye. Jun 06, 2014 the pupillary pathway and its clinical aspects slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. A relativeafferentpupillary defect, commonly referred to as the marcus gunn pupil, points to asymmetric function of the retina or optic nerve. This will often result in one pupil appearing larger than the other relative afferent pupillary defect rapd. Relative afferent pupillary defect rapd, marcus gunn pupil an rapd is a defect in the direct response. Relative afferent pupillary defect definition of relative.
Afferent pupillary defect definition of afferent pupillary. 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. This compares the direct and consensual pupillary constriction of each eye to look for a difference in the afferent conduction between them, called a relative afferent pupillary defect rapd. Aim to evaluate the association between the magnitude of relative afferent pupillary defect rapd and the laterality of visual fields in glaucoma patients using pupillography. Backgroundrelative afferent pupillary defects are typically related to ipsilateral lesions within the anterior visual pathways.
Rapd, relative afferent pupillary defect, marcusgunn. The sign causes much confusion, but in reality is a very simple sign. Relative afferent pupillary defect ophthalight digital solutions. The relative afferent pupillary defect is a dynamic process that results from an imbalance of brightness sensitivity between the two eyes. The question of whether an rapd may be present in a completely healthy subject has been addressed in observational and pupillographic studies. The prevalence of relative afferent pupillary defects in nor. Reliability of brightness comparison testing in predicting. Detecting a relative afferent pupillary defect using the. This article seeks to outline the neural pathway underlying pupil constriction and provides a guide to assessing pupillary light reaction to. Relative afferent pupillary defects in homonymous visual. The light reflex pathway showing the afferent path red and the. Isolated relative afferent pupillary defect secondary to.
Previous reports have shown that eyes with retinal detachment have relative afferent pupillary defects. Rapd, relative afferent pupillary defect, marcusgunn pupil. A relative afferent pupillary defect usually indicates disease in the prechiasmal visual pathway. Relative afferent pupillary defect with normal vision in a. Keeping an eye out for the signs and symptoms of brain tumours subconjunctival hemorrhage of the nasal conjunctiva in the left eye and relative. The relative afferent pupillary defect and a novel method of. Afferent pupillary defect article about afferent pupillary. How to test for a relative a erent pupillary defect rapd. This is an important part of the neurological examination of the eye.
In the swinging flashlight test, a light is alternately shone into the left and right eyes. The relative afferent pupillary defect rapd, is also called the marcus gunn pupil, after the ophthalmologist that described the defect in 1883. Relative afferent pupillary defect in the better eye. Light source the swinging light test is used to detect a relative afferent pupil defect rapd. The arrows represent the light this is a common case in pupillary examination. Relative afferent pupillary defects rapd were detected in 32. The first page of the pdf of this article appears above. All underwent standard clinical examination including perimetry and optic disc photography. In this situation, the affected side is said to demonstrate an afferent pupillary defect apd, and the pupil is called a marcus gunn pupil. The pupillary pathway and its clinical aspects slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. A short video demonstrating how to correctly examine a patients pupils to find a relative afferent pupil defect. Measurement of the relative afferent pupillary defect in retinal.
Marcus gunn in 1904, it is clear from his report that the sign was generally known to clinicians of his time. Methods evaluations were made with an rapdx konan medical usa, irvine, california, usa, which is designed to analyse pupil responses to multiple colour stimuli white, red, green, blue, and yellow at multiple. A relative afferent pupillary defect usually occurs in an eye with unilateral or asymmetric optic nerve or extensive retinal disease. Afferent pupillary defect legal definition of afferent. Relative afferent pupillary defects rapd may be detected in patients with occipital lobe lesions. Wernicke reported that the pupillary afferent fibre pathway departs from the visual pathway at the optic tract.
The aim of this retrospective study was to estimate the frequency of relative afferent pupillary defect rapd in glaucoma and whether its occurrence relates to the severity of the visual field. For subjects with relative afferent pupillary defects, the measurements of the worth 4dot neutralization test were equal before and after pupillary dilation. Although the relative afferent pupillary defect was described by r. A clinical evaluation of the pupillary response reveals valuable information about the integrity of the structures involved in the pupil reflex. These cases illustrate the proper steps to take in managing your patients. Pupillographic investigation of the relative afferent pupillary defect. Emergency atlas of afferent pupillary defect marcus. Relative afferent pupillary defect, or afferent pupillary defect. We tested the reliability of brightness comparison testing in predicting relative afferent pupillary defects rapds in 206 patients.