There is a presence of weak pupillary constriction followed by pupillary dilation when light is directed in the affected eye. However a defect in the afferent nerve does not necessarily have to be in the optic nerve itself, it could be at the optic chiasm likely to be bilateral, or in the optic tract. The sign causes much confusion, but in reality is a very simple sign. A normal response would be equal constriction of both pupils, regardless of which eye the light is directed at. Pupil diameter is subject to continuous variations as a function of changes in luminance, fixation and psychosensitive stimuli. A marcus gunn pupil, also known as a relative afferent pupillary defect rapd, is a nonspecific sign on physical examination that indicates partial optic nerve dysfunction. The prevalence of relative afferent pupillary defects in normal subjects article in journal of neuroophthalmology 274. This video is part of the eyes have it website and eyes have it mobile app. Objective to describe a patient who had a workup for headache and was found to have an isolated left relative afferent pupillary. Association between a relative afferent pupillary defect using pupillography and inner retinal atrophy in optic nerve disease go takizawa,1. Quantifying relative afferent pupillary defects using a. Both pupils constricted to light stimulus, and no afferent pupillary defect could be seen.
Pupillary abnormalities pdf sudden loss of vision and. 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. Mar 11, 2020 an afferent pupillary defect is an eye condition where one eye is less sensitive to light, and will not contract as sharply in response to light as the unaffected eye. In most cases this would include the presence of a relative afferent pupillary defect rapd see chapter 3. 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. An rapd is due to unilateral or asymmetrical disease of the retina or optic nerve. The swinging flashlight test to detect a relative afferent pupillary defect rapd is an established way of assessing retinal and optic nerve function. Relative afferent pupillary defect rapd, marcus gunn pupil an rapd is a defect in the direct response. Sep 15, 2008 published september 15, 2008 back to the basics, part 5. How to test for a relative a erent pupillary defect rapd. Afferent pupillary defect definition of afferent pupillary. Even in an unconscious patient, the determination of an rapd can be made. 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 sbisa bar. This person with apd is often unaware of it except by looking in a mirror. Cn2 governs sight, and is thus stimulated by light. T1 a unilateral cataract produces a relative afferent pupillary defect in the contralateral eye. The swinging light test is used to detect a relative. Relative afferent pupillary defect marcus gunn pupil on vimeo. Jan 29, 20 this video demonstrates pupillary response testing and how to assess and grade relative afferent pupillary defects with an overview of the general anatomic pathways. 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. Emergency atlas of afferent pupillary defect marcus. This is an important part of the neurological examination of the eye. Association between a relative afferent pupillary defect using pupillography and inner retinal atrophy in optic nerve disease go takizawa,1 atsushi miki, fumiatsu maeda,4 katsutoshi goto,1 syunsuke araki,1 yoshiaki ieki,1 junichi kiryu,1 kiyoshi yaoeda3,5 1department of ophthalmology, kawasaki medical school, 2department of sensory science, faculty of health science and technology. These cases illustrate the proper steps to take in managing your patients.
The sympathetic outflow to the iris dilator muscle is a paired right and left, 3neuron chain without decussation figure 4. A clinical evaluation of the pupillary response reveals valuable information about the integrity of the structures involved in the pupil reflex. Marcus gunn pupil relative afferent pupillary defect. We prospectively studied patients with relative afferent pupillary defects by using the swinging flashlight test with a standardized. 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. To determine the frequency with which a relative afferent pupillary defect rapd occurs in patients with glaucoma but without vf loss when tested with. A good understanding of the anatomy of the oculosympathetic pathway is critical when evaluating a patient with horner syndrome. Pdf how to test for a relative afferent pupillary defect rapd. The presence of the relative afferent pupillary defect best correlates with asymmetric, visualfield loss in the more severely affected eye. Optic nerve ii this is the afferent nerve it detects the light, and sends this signal to the brain. 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. The swinging light test is used to detect a relative aerent pupil defect rapd. Relative afferent pupillary defect how to test for a relative a erent pupillary defect rapd david c.
The pupillary pathway and its clinical aspects slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Find it by a swinging flashlight test a medical term. Isolated relative afferent pupillary defect secondary to. Full text get a printable copy pdf file of the complete article 1.
Relative afferent pupillary defect screening through transfer learning. In this situation, the affected side is said to demonstrate an afferent pupillary defect apd, and the pupil is called a marcus gunn pupil. If this asymmetry is of a sufficient magnitude, all patients with a complete homonymous hemianopia caused by an isolated tract lesion should have a relative afferent pupillary defect in the eye with the temporal field loss contralateral to the side of the lesion. Relative afferent pupillary defect description, causes and risk factors. The swinging light test is used to detect a relative afferent pupil defect rapd. The anterior midbrain, controlling pupillary size, receives a message from the affected eye that illumination is reduced as compared with the fellow eye.
Association between a relative afferent pupillary defect using pupillo. A unilateral cataract produces a relative afferent. This can be a sign of optic nerve damage, tumor, glaucoma, and a number of other eye issues. An appreciation of the anatomy and understanding of the mechanisms involved in abnormal pupil responses, knowledge of the proper technique of the swinging flashlight test, and an awareness of potential pitfalls in performing this test will aid the physician in the detection of an afferent pupillary defect. Relative afferent pupillary defect, or afferent pupillary. N2 the relative afferent pupillary defect rapd was measured with neutral density filters in ten patients, each of whom had a dense cataract in one eye only. Association between a relative afferent pupillary defect. Abnormalities in pupillary light reflex can indicate optic nerve disorders that may lead to permanent visual loss if not diagnosed in an.
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. An afferent pupillary defect apd, or marcus gunn pupil results from a lesion of the optic nerve e. 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. Moving a bright light from the unaffected eye to the affected eye would cause both eyes to dilate, because the ability to perceive the bright light is diminished. The prevalence of relative afferent pupillary defects in. How to test for a relative afferent pupillary defect rapd ncbi. Relative afferent pupillary defects rapd were detected in 32. Feb 08, 2020 optic nerve ii this is the afferent nerve it detects the light, and sends this signal to the brain. In the setting of claimed complete visual loss in 1 eye only, other evidence to support optic nerve dysfunction should be present. Jul 05, 2017 marcus gunn pupil is also known as marcus gunn sign and relative afferent pupillary defect rapd. This is a normal finding, and the pupils constrict equally to light with absence of redilation. Relative afferent pupillary defect definition of relative. Learn vocabulary, terms, and more with flashcards, games, and other study tools. To be able to accurately interpret the results of pupil testing in terms of both a relative afferent pupillary defect and anisocoria.
To properly and thoroughly evaluate both the afferent and the efferent pupillary function. Relative afferent pupillary defect rapd is a medical sign observed during the swingingflashlight test whereupon the patients pupils dilate when a bright light. Jun 20, 2014 this video is part of the eyes have it website and eyes have it mobile app. A marcus gunn pupil indicates an afferent defect, usually at the level of the retina or optic nerve. Also known as a marcusgunn pupil, the afferent pupillary defect is due to dysfunction of cranial nerve 2 optic nerve. Examination of the pupillary responses revealed the presence of a left relative afferent pupillary defect rapd and ophthalmoscopy of the fundi showed no evidence of optic nerve pathology and there were no vascular changes noted in the retina. An unusual manifestation of carotid artery dissection. Emergency atlas of afferent pupillary defect marcus gunn.
A relative afferent pupillary defect can be an ominous exam finding. T1 brightness sense and the relative afferent pupillary defect. The swinging flashlight test1,2 has widely been used in the clinical setting as a simple and easy method for detecting a relative afferent pupillary defect rapd. An external file that holds a picture, illustration, etc. Its when the eyes pupil only slightly contracts or dilates when light shines over it. A doctor can identify this defect with the swinging light test, where she moves a light rapidly back and forth between the eyes to. Afferent visual system cases visual pathway cases flashcards. Marcus gunn pupil is also known as marcus gunn sign and relative afferent pupillary defect rapd. If you continue browsing the site, you agree to the use of cookies on this website. After consideration of various clinical investigations the significant factors identified. An afferent pupillary defect is an eye condition where one eye is less sensitive to light, and will not contract as sharply in response to light as the unaffected eye. Afferent pupillary defect synonyms, afferent pupillary defect pronunciation, afferent pupillary defect translation, english dictionary definition of afferent pupillary defect.
How to test for a relative afferent pupillary defect rapd. Marcus gunn pupil an overview sciencedirect topics. Relative afferent pupillary defect indiana university. A relativeafferentpupillary defect, commonly referred to as the marcus gunn pupil, points to asymmetric function of the retina or optic nerve. In a very dark room, shine a penlight in the left eye. To assess the validity and reproducibility of quantitating relative afferent pupillary defects with the swinging flashlight test, using a 3second pause technique, and to compare this grading system with that using neutral density filters. Westphal nuclei innervate the iris pupillary sphincter muscle. A relative afferent pupillary defect rapd or marcus gunn pupil is a sign of damage to the optic nerve, which can be a symptom multiple sclerosis ms.
This will often result in one pupil appearing larger than the other relative afferent pupillary defect rapd. This step com pares the afferent pupillary responses of one eye to the. Relative afferent pupillary defect in eyes with retinal. The nasal visual field is considerably smaller than the temporal field. The amplitude, latency and speed of pupil constriction after a lightstimulus are generally correlated to the visual acuity of thepatient, except in cases in which the visual defect is secondary to a circumscribed foveal lesion or a bilateral occipital pathology, inwhich pupil activity is normal. This video demonstrates pupillary response testing and how to assess and grade relative afferent pupillary defects with an overview of the general anatomic p. Pdf how to test for a relative afferent pupillary defect. By accurately quantifying the defect additional information can be provided, which may aid managementfor example. The prevalence of relative afferent pupillary defects in patients. The relative afferent pupillary defect rapd, is also called the marcus gunn pupil, after the ophthalmologist that described the defect in 1883. To understand when the pupil findings suggest a neuroophthalmic disease process that requires further workup evaluation. Relative afferent pupillary defect symptoms, causes, icd. Brightness sense and the relative afferent pupillary defect. Brightness sensitivity and color perception as predictors of.
Relative afferent pupillary defect in optic tract hemianopias. Both anterior segments were clear with no evidence of inflammation or acute glaucoma. David lazar, md, adam rodman, ba, and gabriel vidal, md. Objective assessment of a relative afferent pupillary defect by b. The firstorder neuron central originates in the hypothalamus and descends through the brainstem into the lateral column of the spinal cord. N2 a patient with a damaged optic nerve may complain that the world seems darker with the bad eye. Start studying afferent visual system cases visual pathway cases.
Request pdf on mar 1, 2006, helen v daneshmeyer and others published relative afferent pupillary defect, or afferent pupillary defect. 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. Rapd rapd stands for random amplification of polymorphic dna. With diminished afferent stimulation, less light is perceived, and pupil contraction diminishes ie, dilates as a result. It is a type of pcr reaction, but the segments of dna that are amplified are random. Background relative afferent pupillary defects are typically related to ipsilateral lesions within the anterior visual pathways. There was a peripheral iris adhesion to clear cornea nasally at the 9oclock position. Relative afferent pupillary defect ophthalight digital. 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. It is typically related to lesions within the anterior visual pathways. Relative afferent pupillary defect ophthalight digital solutions. How to test for a relative afferent pupillary defect rapd article pdf available in community eye health international centre for eye health 257980.
Relative afferent pupillary defects in primary openangle. Clinical grading of relative afferent pupillary defects. 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 marcus gunn pupil is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye. It is due to damage inoptic nerve or severe retinal disease. Relative afferent pupillary defect indiana university youtube.
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