![]() The normal pupil varies in size, depending on the ambient illumination. If not, do they react to a near target?.Do the pupils react to a light stimulus?. ![]() Are the pupils round or irregularly shaped?.The mnemonic PERRLA (pupils equal, round, reactive to light, and accommodation)reminds us of the four questions we should ask in evaluating the pupils: Pupillary function is an important objective clinical sign in patients with visual loss and neurologic disease. The information below is from Neuro-ophthalmology Illustrated-2nd Edition. Pharmacological testing in Horner’s syndrome – a new paradigm. Because the afferent pathways serving the light reflex and the near reflex are anatomically distinct, patients with severe optic neuropathies will still have intact, brisk pupillary responses to near stimuli, while their pupils will not, or will only poorly, react to light. If a patient with a suspected optic neuropathy has no relative afferent pupillary defect, either the patient does not have an optic neuropathy or the optic neuropathy is bilateral. A relative afferent pupillary defect does not cause anisocoria. Presence of a relative afferent pupillary defect (RAPD) Response to light (direct and consensual response) If a patient has severe bilateral optic neuropathy will the pupils respond to near stimuli? If there is no relative afferent pupillary defect in a patient is suspected of having optic neuropathy (regardless of the cause) does that rule-out this diagnosis?Ĥ. Does a relative afferent pupillary defect cause anisocoria?ģ. When examining the pupils, what 6 items should be recorded?Ģ.
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