II. Indication
III. Physiology
- See Pupil
IV. Technique
- Preparation
- Use a bright flashlight
- Perform in a semi-dark room (but light enough to see bilateral pupil reaction)
- Move the flashlight from directly in front of one eye, to directly in front of the other
- Maintain a constant distance between flashlight and eye
- Avoid maintaining a central point at nose (stimulates near response)
- Check left eye response (direct and consensual)
- Shine light on left eye for 3 seconds and check left pupil reflex
- Shine light on right eye for 3 seconds and check left pupil reflex
- Check right eye response (direct and consensual)
- Shine light on right eye for 3 seconds and check right pupil reflex
- Shine light on left eye for 3 seconds and check right pupil reflex
V. Findings: Normal response
VI. Findings: Abnormal - Afferent lesion (RAFD, Marcus Gunn Pupil)
- Findings: Relative Afferent Pupillary Defect (RAFD)
- No pupil response to direct light
- Intact Consensual Light Reflex (when light shone in opposite eye)
- Paradoxical Pupil Dilation to direct light
- Occurs on moving light from opposite to affected eye (Swinging Flashlight Test)
- Causes: Optic Nerve Lesion (rarely at Retina)
- Ischemic Optic Neuropathy
- Optic Neuritis (e.g. Multiple Sclerosis)
- Optic Nerve compression or Trauma
- Glaucoma (asymmetric)
- Other Optic Neuropathy (e.g. infiltrative, radiation, infectious)
- References
VII. Findings: Abnormal - Efferent lesion (CN 3 or pupillary Muscle)
- Affected eye loses consensual and Direct Light Reflex
- Unaffected eye maintains consensual and direct reflex
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Finding (T033) |
| MSH | D011681 |
| SnomedCT | 8099001, 232121005 |
| English | APD - Afferent pupil defect, Marcus-Gunn pupil, Marcus Gunn pupil (dilates to light), Marcus Gunn pupil (physical finding), the pupils reacted consensually but then dilated in the presence of direct light, Afferent Pupillary Defects, Pupillary Defect, Afferent, Pupillary Defects, Afferent, Marcus Gunn Pupil, Marcus-Gunn Pupil, Pupil, Marcus-Gunn, afferent pupillary defect, marcus gunn pupil, gunn marcus pupils, Marcus-Gunn pupillary sign, Marcus-Gunn pupillary sign (finding), Swinging flashlight sign, Marcus Gunn pupil, APD - Afferent pupillary defect, Afferent pupillary defect, Afferent pupillary defect (disorder), Marcus-Gunn sign, Afferent Pupillary Defect |
| Dutch | Marcus Gunn-pupil, Afferent pupildefect, Marcus-Gunn-pupil |
| French | Pupille de Marcus Gunn, Déficit pupillaire afférent, Pupille de Marcus-Gunn |
| German | Marcus Gunn-Pupille, Afferenter Pupillendefekt, Marcus-Gunn-Pupille |
| Portuguese | Pupila de Marcus Gunn, Defeito Pupilar Aferente, Pupila de Marcus-Gunn |
| Spanish | Pupila de Marcus Gunn, Defecto Pupilar Aferente, signo pupilar de Marcus - Gunn, signo pupilar de Marcus - Gunn (hallazgo), defecto pupilar aferente (trastorno), defecto pupilar aferente, Pupila de Marcus-Gunn |
| Japanese | マーカス・ガン瞳孔, ﾏｰｶｽｶﾞﾝﾄﾞｳｺｳ |
| Czech | Marcus Gunnova zornice |
| Hungarian | Marcus Gunn pupilla |
| Norwegian | Marcus Gunns pupill, Marcus Gunns fenomen, Marcus Gunns syndrom, Afferent pupilldefekt |
| Italian | Pupilla di Marcus Gunn, Difetto pupillare afferente |
Ontology: Pupil reactivity (C0517966)
| Concepts | Finding (T033) |
| English | Pupil reactivity |
Ontology: Absence of direct light pupillary reflex (C0522341)
| Concepts | Finding (T033) |
| SnomedCT | 103273009 |
| English | Absence of direct light pupillary reflex, Absence of light reflex, Loss of light reflex, Absence of direct light pupillary reflex (finding) |
| Spanish | ausencia a la luz directa, ausencia de reflejo pupilar a la luz directa (hallazgo), ausencia de reflejo pupilar a la luz directa, pérdida del reflejo a la luz |
Ontology: Pupillary light reflex tests (C0853996)
| Concepts | Diagnostic Procedure (T060) |
| Italian | Prove del riflesso pupillare alla luce, Prova del riflesso pupillare alla luce |
| Dutch | lichtreflextest pupil, pupil-lichtreflextests |
| French | Tests de réponse pupillaire à la lumière, Tests de réflexe pupillaire à la lumière |
| Portuguese | Provas de reflexo pupilar, Provas de reflexo pupilar à luz |
| Japanese | 瞳孔対光反射試験, ﾄﾞｳｺｳﾀｲｺｳﾊﾝｼｬｼｹﾝ |
| Czech | Testy červeného reflexu |
| English | Light reflex tests pupillary, Pupillary light reflex tests |
| Hungarian | Pupilla fényreflex vizsgálatok, Pupilla fény reflex vizsgálatok |
| Spanish | Pruebas del reflejo pupilar |
| German | Pupillenlichtreflextests |
Ontology: Swinging flashlight tests (C0858381)
| Concepts | Diagnostic Procedure (T060) |
| Dutch | bewegend flitslichtonderzoek |
| French | Swinging flashlight test |
| German | Swinging-flashlight-Test |
| Italian | Test con luce lampeggiante in movimento |
| Portuguese | Provas de cintilação rítmica |
| Spanish | Pruebas de destellos oscilantes |
| Japanese | 交互対光反射試験, ｺｳｺﾞﾀｲｺｳﾊﾝｼｬｼｹﾝ |
| Czech | Testy reakce zornic na střídavý osvit |
| English | Swinging flashlight tests |
| Hungarian | Ingalámpa vizsgálatok |
