Relative afferent pupillary defect medical student. An afferent pupillary defect apd, or marcus gunn pupil results from a lesion of the optic nerve e. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced. Association between a relative afferent pupillary defect using pupillography and inner retinal atrophy in optic nerve disease. The study was designed to ascertain the relationship between visual loss in the central 30 of vision and the density of the relative afferent pupillary defect apd. Marcus gunn pupil is also known as marcus gunn sign and relative afferent pupillary defect rapd. Clinical grading of relative afferent pupillary defects. Relative afferent pupillary defect in optic tract hemianopias. Rapd, relative afferent pupillary defect, marcusgunn pupil. It is due to damage inoptic nerve or severe retinal disease. It is due to damage inoptic nerve or severe retinal. To observe these examples, move the mouse pointer over the pupil or each eye as if it were a light pen. Origin of the relative afferent pupillary defect in optic tract lesions.
Only the swinging flashlight test uncovers the afferent abnormality in these patients i. The direct and consensual pupillary responses to light are normal. Start studying afferent visual system cases visual pathway cases. There is a presence of weak pupillary constriction followed by pupillary dilation when light is directed in the affected eye. Learn vocabulary, terms, and more with flashcards, games, and other study tools. 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 swinging light test is used to detect a relative afferent pupil defect rapd. 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. Afferent pupillary defect synonyms, afferent pupillary defect pronunciation, afferent pupillary defect translation, english dictionary definition of. Relative affective pupillary defect affective limb. Its when the eyes pupil only slightly contracts or dilates when light shines over it. Pdf how to test for a relative afferent pupillary defect.
This person with apd is often unaware of it except by looking in a mirror. Relative afferent pupillary defect definition of relative. Each relative afferent pupillary defect was graded as follows. A short video demonstrating how to correctly examine a patients pupils to find a relative afferent pupil defect. These cases illustrate the proper steps to take in managing your patients. 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. We prospectively studied patients with relative afferent pupillary defects by using the swinging flashlight test. Abnormalities of pupil isocoria with normal pupil size relative afferent pupillary defect bilateral afferent pupillary defect anisocoria with dilated pupil in the affected eye complete oculomotor palsy tonic pupil iris defects following eyedrop application anisocoria with a. Association between a relative afferent pupillary defect. Because of the inability to control the intraocular pressures despite the presence of a relative afferent pu pillary defect or pupillary escape phe nomenon is indicative of a defect in the anterior visual pathway almost always anterior to the chiasm. Problems in the afferent half of the pupillary light reflex e. It is a type of pcr reaction, but the segments of dna that are amplified are random. Significantly, the left pupil was minimally reactive. The swinging light test shows abnormal light response of the.
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. Even in an unconscious patient, the determination of an rapd can be made. The marcus gunn pupil is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye. Richmond eye associates, relative afferent pupillary defect. Relative afferent pupillary defect ophthalight digital solutions. How to test for a relative afferent pupillary defect rapd. In the setting of claimed complete visual loss in 1 eye only, other evidence to support optic nerve dysfunction should be present. A relative afferent pupillary defect is an examination finding in patients who have an asymmetric pupillary reaction to light when it is shined back and forth.
Relative afferent pupillary defectmarcus gunn pupil youtube. A second common cause of marcus gunn pupil is a contralateral optic tract lesion, due to the different contributions of the intact nasal and temporal hemifields. After consideration of various clinical investigations the significant factors identified. Asymmetrical differences in retinal appearance or optic nerve. Optic nerve ii this is the afferent nerve it detects the light, and sends this signal to the brain. Relative afferent pupillary defect medical student education duration. Origin of the relative afferent pupillary defect in optic. A marcus gunn pupil indicates an afferent defect, usually at the level of the retina or optic nerve. This defect may have occurred during any stage of glaucoma, but the presence of this sign may be indicative of the earliest onset of optic nerve damage in patients with ocular hypertension. Relative afferent pupillary defect in eyes with retinal. Jun 20, 2014 this video is part of the eyes have it website and eyes have it mobile app. Seven patients with asymmetrical openangle glaucoma had relative afferent pupillary defects.
Is the afferent or efferent pathway defective in rapd. Relative afferent pupillary defect in eyes with retinal detachment. This will often result in one pupil appearing larger than the other relative afferent pupillary defect rapd. Afferent visual system cases visual pathway cases flashcards. To determine the percent decussation of pupil input fibers in humans and to explain the size and range of the log unit relative afferent pupillary defect rapd in patients with optic tract lesions. An rapd is due to unilateral or asymmetrical disease of the retina or optic nerve. 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. We prospectively studied patients with relative afferent pupillary defects by using the swinging flashlight test with a standardized illumination time of 3 seconds pause time for each eye. How to test for a relative afferent pupillary defect rapd ncbi. The relative afferent pupillary defect rapd, is also called the marcus gunn pupil, after the ophthalmologist that described the defect in 1883. Afferent pupillary defect definition of afferent pupillary. Pupil setup, calibration, and recording walkthrough. 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. Its when the eyes pupil only slightly contracts or.
Sep 15, 2008 published september 15, 2008 back to the basics, part 5. Apr 05, 2008 a short video demonstrating how to correctly examine a patients pupils to find a relative afferent pupil defect. Relative afferent pupillary defect ophthalight digital. 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. 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.
Relative afferent pupillary defects rapd were detected in 32. Relative afferent pupillary defect screening through transfer learning. Correlation of afferent pupillary defect with visual field loss on automated perimetry lenworth n. From the department of medicine, roodlands general hospital, haddington eh41 3pf, uk. Relative afferent pupillary defect medical student education author. The swinginglighttest is used to check for relative afferent pupillary defect rapd. Its when the eyes pupil only slightly contracts or dilates when light shines over it, instead of shrinking immediately like it should. In this study, we focus on relative afferent pupillary defect rapd, which is based on the difference between the reactions of the eyes when. Relative afferent pupillary defect rapd, marcus gunn pupil. Sixtyfive participants were recruited 32 with open.
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. A case of functional psychogenic monocular hemianopia analyzed by measurement of hemifield visual evoked potentials. This left relative afferent pupillary defect rapd persisted throughout his hospitalization. Rapd, relative afferent pupillary defect, marcusgunn.
Relative afferent pupillary defect rapd is a medical sign observed during the swingingflashlight test whereupon the patients pupils dilate when a bright light is swung from the unaffected eye to the affected eye. The patient did not blink to threat on testing of his left eye. A relative afferent pupillary defect can be an ominous exam finding. To study the presence of relative afferent pupillary defect rapd in patients with glaucoma with the help of a custombuilt pupillometer. Relative afferent pupillary defect rapd relative afferent pupillary defect rapd simulator. Pupillary responses stanford medicine 25 stanford medicine. In these cases, assume that the testing is being done in a dimly illuminated room. Abnormal reactions of pupil lamyaa anwar alghafli 211523025. Feb 08, 2020 optic nerve ii this is the afferent nerve it detects the light, and sends this signal to the brain. 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.
The visual acuity in the left eye remained poor at 648 and the afferent pupillary defect also persisted. Pdf how to test for a relative afferent pupillary defect rapd. Associating the magnitude of relative afferent pupillary defect rapd with visual field indices in glaucoma patients. The sign causes much confusion, but in reality is a very simple sign. The swinging light test is used to detect a relative. Correlation of afferent pupillary defect with visual field. A defect of the pupillary reflex caused by a lesion along the pathway of either the parasympathetic supply from the edingerwestphal nucleus to the sphincter pupillae muscle of the iris adies pupil, or the ocular sympathetic supply from the ciliospinal centre to the dilator pupillae muscle of the iris horners. During a swinging flashlight test, the right pupil constricted from 4 mm to 2 mm, while the left remained at 5 mm. The arrows represent the light this is a common case in pupillary examination. 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. Although glaucoma usually is bilateral, asymmetry is common and patients often have intereye differences in iop, 1 retinal nerve fiber layer rnfl thickness, 2 and standard automated perimetry sap sensitivity. Outline anatomy physiology clinical examination afferent pathway defects efferent pathway 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.
Schiefer u, dietzsch j, dietz k, wilhelm b, bruckmann a, wilhelm h, kitiratschky v, januschowski k br j ophthalmol 2012 may. 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. This one habit will truly change your life animated story. Simulators pupils, the pupil is a hole located in the center of the iris of the eye that allows light to enter the retina. Relative afferent pupillary defect in glaucoma sciencedirect. Rapd, relative afferent pupillary defect, marcusgunn pupil neuroophthalmology with dr.
Afferent pupillary defect article about afferent pupillary. If one of the eyes isnt detecting light well, then the pupils will not constrict as well when light is shined in that eye. 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. Rapd relative afferent pupillary defect rapd cause a reduction in pupil contraction when. This video is part of the eyes have it website and eyes have it mobile app. Relative afferent pupillary defect rapd is a medical sign observed during the swingingflashlight test whereupon the patients pupils dilate when a bright light. Relative afferent pupillary defect rapd moran core. There was no relative afferent pupillary defect, and a color perception test was normal. Relative afferent pupillary defect rapd, marcus gunn pupil an rapd is a defect in the direct response. 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.
Marcus gunn pupil relative afferent pupillary defect. If all is normal, both pupils will remain constricted. Rapd may be associated with visual field or electroretinographic asymmetries between the two eyes. Relative afferent pupillary defect interactive clinical examples. How to test for a relative a erent pupillary defect rapd. This is an important part of the neurological examination of the eye. Visual pathways and pupil defects questions and study. Jun 06, 2014 rapd relative afferent pupillary defect rapd cause a reduction in pupil contraction when one eye is stimulated by light compared with when the opposite eye is stimulated by light. Marcus gunn pupil an overview sciencedirect topics. Relative afferent pupillary defect symptoms, causes, icd. Nov 11, 2015 relative afferent pupillary defect medical student education duration.
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