pupillary reflex ophthal.pptx

Pupillary reflex examination

1. EXAMINATION of pupillary reflex Direct light reflex Consensual light reflex Swinging flash light test Near reflex

2. Direct light reflex PATIENT SEATED IN A DIMLY LIT ROOM ONE EYE CLOSED WITH PALM NARROW BEAM OF LIGHT SHOWN TO OTHER PUPIL RESPONSE-NORMALLY PUPILS CONSTRICT

3. Consensual light reflex Patient seated in dimly lit room 2 eyes are separated by an opaque curtain kept at the level of nose One eye exposed to beam of light Pupillary response observed at the other eye Response-normally contralateral pupil

4. Swinging flash light test Performed when relative afferent pathway defect suspected in one eye Bright flash light shone to one pupil constriction is noted Quickly moved to contralateral pupil and response is noted Repeated several times Normally both pupils constrict equally

5. Marcus gunn pupil(relative afferent pupillary defect-rapd) In the presence of relative affluent pathway defect in one eye the affected pupil will dilate when the flashlight is moved from the normal eye to abnormal eye Significance-earliest indication of optic nerve disease even in the presence of normal visual acquity

6. Near reflex Patient asked to focus a near object Then suddenly focus an object held about 15 cm from patient’s eye While the patient’s eye converges and focuses the near object there is pupillary constriction

7. Abnormal pupillary reactions Amaurotic pupil Efferent pathway defect Wernickes hemianopic pupil Marcus gunn pupil Argyll Robertson pupil The tonic pupil