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Perform the Pupillary Exam

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Title: Pupillary Exam

Author: Marshall Huang, 4th Year Medical Student, University of Pittsburgh

Performing the Pupillary Exam

The pupillary exam is considered one of the “vital signs” of ophthalmology. It is important to assess the pupils of all patients because any abnormalities can be a sign of a serious neurological disease.  A complete pupillary exam includes assessing the direct and consensual response to light, as well as the near response. Any asymmetry should prompt further evaluation.  Here are the basic steps of performing the pupillary exam:

  1. Have patient fixate on a distant target and turn the room lights down
  2. Measure the pupillary diameters of each eye separately in both light and dark
    1. This is the best way to detect anisocoria (unequal pupil diameters). Anisocoria can be physiologic or normal if the difference in diameter is the same in light and dark.
  3. Shine a light in one eye and measure the constriction in the illuminated eye (direct) and the constriction of the other eye (consensual)
    1. Both pupils should constrict simultaneously and equally
  4. Perform the swinging light test (see RAPD for more details)
  5. In moderate light, have the patient shift their gaze from a distant target to a near object
    1. Both pupils should constrict simultaneously and equally (see light/near dissociation for more information)

See Also in the CORE:

The Neuro-ophthalmology Exam: Pupils; Color; Eye Movements; Prism

Identifier: Moran_CORE_23989