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Chapter: Ophthalmology: Pupil

Isocoria with Normal Pupil Size

Relative Afferent Pupillary Defect: Causes: Unilateral sensory disorder such as retinal detachment, neuritis ofthe optic nerve, atrophy of the optic nerve, or retinal vascular occlusion.

Isocoria with Normal Pupil Size


Relative Afferent Pupillary Defect

Causes: 

Unilateral sensory disorder such as retinal detachment, neuritis ofthe optic nerve, atrophy of the optic nerve, or retinal vascular occlusion.

Diagnostic considerations:

Direct light reflex is decreased or absent (relative afferent pupillary defect) in the affected eye.

The consensual light reflex in the affected eye is weak or absent but normal in the unaffected eye.

The swinging flashlight test reveals dilation in the affected eye when illuminated (Marcus Gunn pupil) or reduced constriction and earlier dila-tion in the presence of lesser lesions (afferent pupillary defect).

Near reflex is normal.

Unilaterally reduced visual acuity and/or field of vision.

Unilateral blindness (afferent defect) does not produce anisocoria.

Bilateral Afferent Pupillary Defect

Causes: 

Bilateral sensory disorder such as maculopathy or atrophy of theoptic nerve.

Diagnostic considerations:

Delayed direct and consensual light reflexes.

The swinging flashlight test produces identical results in both eyes (where disorder affects both sides equally).

Near reflex is normal.

Bilaterally reduced visual acuity and/or field of vision.

 

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