This finding is present in every RAPD, but most examiners are used to only observing the affected pupil during the swinging flashlight test. Reverse RAPD, or reverse testing for RAPD, utilizes the swinging flashlight test while evaluating the normal, unaffected pupil for dilation. Where one eye has an efferent pupillary defect (e.g., iris posterior synechiae, trauma, third nerve palsy, or pharmacological mydriasis), a ‘reverse RAPD’ test can be employed. Testing for a RAPD requires two eyes, but only one functioning pupil. Dense macular lesions (chorioretinal scar).Ischemia (e.g., ischemic central retinal vein occlusion or central retinal artery occlusion).Lesions of the optic nerve, regardless of the cause of optic neuropathy (e.g., optic neuritis, glaucoma, compression, infection etc.).Occur in lesions affecting the visual pathway in front of the lateral geniculate body including: The RAPD is a critically important sign in patients with unexplained visual loss because it is an objective finding of afferent pupillary dysfunction. The pathologic response that characterizes the RAPD includes the following: 1) the light reaction causes pupil constriction in both eyes when the light shines in the normal eye, and (2) dilatation of the pupils in both eyes when the light stimulus is rapidly transferred from the normal eye to the pathologic eye. The normal pupillary response is characterized by equal constriction of the pupils in both eyes when the light stimulus is applied to each eye individually and no dilation or pupillary escape when the light swings from one eye to the other. In the case of an afferent pupillary pathway lesion, the light response is tested individually in each eye, and then the light swings between the two eyes in order to detect an RAPD. In a normal patient without afferent pupillary disease, shining a light in either eye will produce constriction in both eyes equally. Patients do not have anisocoria.Ī RAPD is seen in unilateral or bilateral but asymmetric lesions of the prechiasmal optic nerve starting from the retina but can occur anywhere in the afferent pupillary pathway including the optic tract and the pretectal afferent fibers in the dorsal midbrain. The test requires two eyes but only one working pupil. The RAPD manifests as a difference in pupillary light reaction between the two eyes. An RAPD is relative to the fellow eye and occurs because of the bilateral and equal innervation of the pupils in normal individuals. 2.2 Lesions of the Retina/Posterior SegmentĪ relative afferent pupillary defect (RAPD) also known as a Marcus Gunn pupil, is a critically important ophthalmological examination finding that defines a defect ( pathology) in the pupil pathway on the afferent side.2.1 Lesions of the Anterior Optic Pathway.For all questions related to Pupil Path, please contact your school. If you have not received your invitation letter, or have lost your letter, please contact the Pupil Path point person at your school. This letter will provide you with your student’s OSIS (ID) number and the registration code you need in order to sign up. You will be receiving or have already received a Pupil Path invitation letter from your school. If you have forgotten your password click “Forgot Your Password?” and follow the instructions:įor parents you will be prompted to input your E-mail address and select your school.įor students you will be prompted to return to the Login Screen and re-register to reset your password.įirst, you must register on Pupil Path. Students login with their 9-digit student OSIS Numbers. If you used Pupil Path last year you can login with the same E-mail/ID and password you used last year. This is a convenient tool for both parents and students to keep up with class work and student performance. Pupil Path allows parents and students to view important student and school information such as student attendance records, class schedule, assignment due dates and grades, graduation eligibility, school announcements, and more. Pupil Path is a student information system for parents and students.
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