Pupillary Light Reflex

Aka: Pupillary Light Reflex, Swinging Flashlight Test, Marcus Gunn Pupil, Direct Light Reflex, Consensual Light Reflex, Direct Light Pupillary Reflex Loss, Relative Afferent Pupillary Defect, Afferent Pupillary Defect, Pupil Reactivity

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II. Indication

  1. Anisocoria (Unequal Pupils)
  2. Eye Neurologic Exam

III. Technique

  1. Check left eye response (direct and consensual)
    1. Shine light on left eye and check left pupil reflex
    2. Shine light on right eye and check left pupil reflex
  2. Check right eye response (direct and consensual)
    1. Shine light on right eye and check right pupil reflex
    2. Shine light on left eye and check right pupil reflex

IV. Findings: Normal response

  1. Direct Light Reflex
    1. Pupil constricts to direct light
  2. Consensual Light Reflex
    1. Pupil constricts to light shining on opposite pupil

V. Findings: Abnormal - Afferent lesion (Marcus Gunn Pupil)

  1. Causes
    1. Retinal lesion
    2. Optic Nerve lesion
    3. Ischemic Optic Neuropathy
    4. Multiple Sclerosis
  2. Findings
    1. No pupil response to direct light
    2. Intact Consensual Light Reflex
      1. Paradoxical Pupil Dilation to direct light
      2. Occurs on moving light from opposite to affected eye

VI. Findings: Abnormal - Efferent lesion (CN 3 or pupillary Muscle)

  1. Affected eye loses consensual and Direct Light Reflex
  2. Unaffected eye maintains consensual and direct reflex

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Related Studies

Ontology: Afferent Pupillary Defect (C0339662)

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
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Pupil reactivity (C0517966)

Concepts Finding (T033)
English Pupil reactivity
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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