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    The Swinging Flashlight Test: Learning Objective: Facts About The Pupil

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    siti hazard aldina
    The document discusses the swinging flashlight test, which is used to detect a relative afferent pupillary defect (RAPD). When light is swung from one eye to the other in a normally functioning visual system, both pupils will constrict equally. However, if there is damage to the retina or optic nerve on one side, the pupil on the damaged side may paradoxically dilate when light is shone in the good eye, indicating an RAPD. Causes of an RAPD include optic nerve disease, retinal disease, or other conditions affecting the afferent visual pathway. An RAPD is an important clinical sign in ophthalmology, while a cataract will not cause one.

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    The Swinging Flashlight Test: Learning Objective: Facts About The Pupil

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    siti hazard aldina
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    The document discusses the swinging flashlight test, which is used to detect a relative afferent pupillary defect (RAPD). When light is swung from one eye to the other in a normally functioning visual system, both pupils will constrict equally. However, if there is damage to the retina or optic nerve on one side, the pupil on the damaged side may paradoxically dilate when light is shone in the good eye, indicating an RAPD. Causes of an RAPD include optic nerve disease, retinal disease, or other conditions affecting the afferent visual pathway. An RAPD is an important clinical sign in ophthalmology, while a cataract will not cause one.

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    The document discusses the swinging flashlight test, which is used to detect a relative afferent pupillary defect (RAPD). When light is swung from one eye to the other in a normally functioning visual system, both pupils will constrict equally. However, if there is damage to the retina or optic nerve on one side, the pupil on the damaged side may paradoxically dilate when light is shone in the good eye, indicating an RAPD. Causes of an RAPD include optic nerve disease, retinal disease, or other conditions affecting the afferent visual pathway. An RAPD is an important clinical sign in ophthalmology, while a cataract will not cause one.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    55 views3 pages

    The Swinging Flashlight Test: Learning Objective: Facts About The Pupil

    Uploaded by

    siti hazard aldina
    The document discusses the swinging flashlight test, which is used to detect a relative afferent pupillary defect (RAPD). When light is swung from one eye to the other in a normally functioning visual system, both pupils will constrict equally. However, if there is damage to the retina or optic nerve on one side, the pupil on the damaged side may paradoxically dilate when light is shone in the good eye, indicating an RAPD. Causes of an RAPD include optic nerve disease, retinal disease, or other conditions affecting the afferent visual pathway. An RAPD is an important clinical sign in ophthalmology, while a cataract will not cause one.

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    The Swinging Flashlight Test

    prepared by Dr. L. Weisbrod edited by Dr. R. Adam

    Learning Objective: Review the anatomy, physiology and pathophysiology of the pupil
    Discuss the Relative Afferent Pupillary Defect
    Facts about the Pupil: - central aperture formed by the iris
    - resting position is influenced by sympathetic and
    parasympathetic innervation
    - important in near reflex, allowing or preventing light in the
    eye, cutting down scatter of light
    Miosis: Iris sphincter muscle constricts the pupil via CN3
    Mydriasis: Iris dilator muscle dilates the pupil via Sympathetic chain

    Anisocoria: Unequal pupillary size (physiologic vs pathologic)


    Physiologic Anisocoria: (present in 25% of population)
    - typically < 1 mm asymmetry
    - both pupils equally reactive (in dark and light conditions)
    - difference in pupil sizes does not change in changing light conditions
    Pathologic Anisocoria:
    - typically > 1 mm asymmetry
    - pupils display different amounts of reactivity
    - difference b/w pupil sizes changes with light vs dark conditions
    Mydriatic Disorders: (abnormal pupil unable to constrict; greater asymmetry in light)
    - CN3 Palsy, Acute Angle Closure Glaucoma, Adie’s Pupil, Traumatic Mydriasis
    (Iris trauma), Dilating/Cycloplegic drops
    Miotic Disorders: (abnormal pupil unable to dilate; greater asymmetry in dark)
    - Horner’s Syndrome (lesion in Sympathetic Chain) highlighted by ptosis, miosis,
    anhydrosis
    - Iritis (chronic)
    - cholinergic, anticholinesterase inh. drugs (pilocarpine, carbachol)

    1
    Pathway of Pupillary Reaction to Light

    Like all reflexes has an Afferent Limb


    1. Light stimulates Retina --> down optic nerve (II) to Pretectal nucleus of the Midbrain
    2. Pretectal nucleus --> BOTH (cross midline) Edinger-Westphal nuclei
    Like all reflexes has an Efferent Limb
    3. EW nuclei --> down BOTH Oculomotor nerve (III) to Ciliary Ganglion in oribt
    4. Ciliary Ganglion --> Iris Sphincter muscle (BOTH pupils constrict)

    Swinging Flashlight Test


    - Tools needed: a bright light source and a dimly lit room
    - Technique: turn down lights, ask patient to look straight ahead in the distance, shine a
    bright light source from just under patient’s visual axis, swing light source back and forth
    from one eye to the other allowing the pupil enough time to constrict (count to 3)
    - swinging a light in front of one eye, causes both pupils to constrict
    - the pupillary constriction in the illuminated eye -> DIRECT response
    -the pupillary constriction in the non-illuminated eye --> CONSENSUAL response
    Normally: Direct = Consensual response
    - given that shining a light in one eye will cause constriction of both pupils…..
    swinging the light quickly to the other eye will produce an equal pupillary constriction in
    both eyes
    Relative Afferent Pupillary Defect (Marcus-Gunn Pupil) RAPD
    -But….if there is unilateral or asymmetrical damage to the afferent visual system (retina,
    optic nerve) when you swing the light from the normal side to the affected side, you will
    see paradoxical dilatation of the pupil on the affected side

    2
    Causes of an RAPD:
    Optic Nerve Disease (optic nerve trauma, optic nerve glioma, glaucoma, optic neuritis)
    Retinal Disease (retinal detachment, Central Retinal Artery or vein Occlusion)

    The following NEVER cause an RAPD:


    - cataract
    - corneal scar
    - refractive error
    - vitreous hemorrhage
    - cortical blindness
    - functional visual loss

    Conclusions:
    - Understanding the normal anatomy and physiology of the pupil will allow us to identify
    pathologic anisocoria
    - The relative afferent pupillary defect (RAPD) is one of the most important clinical signs
    in Ophthalmology
    - A white mature cataract will NOT cause an RAPD

    Understanding the normal anatomy and


    will allow us to

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