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Ischemic Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Pupil reactions:2 Pupil reactions are one of the most critical clinical examinations for patients with optic neuropathies. Pupil reactions are checked in a semi-dark room, patient looking into the distance, a bright pen torch light is shone into the eye from slightly below or temporal away from the visual axis for a duration of 3 seconds and quickly moved to the other eye. The procedure is repeated several times until the examiner is sure of the pupil response. This is known as the swinging flashlight test. Normally as the light is shone into each eye by turn the pupils in both eyes shrink. However, if there is a conduction defect in one of the eyes or there is asymmetric optic nerve involvement, as the light is shone into the abnormal/or more abnormal eye, pupils start dilating in both eyes. The eye is then recorded as having a relative afferent pupillary defect (RAPD).
Management of Ophthalmic Injuries by the Forward Surgical Team
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Richard J. Blanch, Johno Breeze, William G. Gensheimer
If one pupil is immobile when testing direct and consensual reflexes, the swinging flashlight test should still be performed. Because direct and consensual pupil reactions are symmetrical, the swinging flashlight test may be performed whilst examining the pupil size of only the eye with the mobile pupil but still swinging the light between both eyes.
The neurological examination
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
S. Shelby Burks, Michael Y. Wang
After assessing extraocular movements, be sure to document any pupillary abnormalities, commenting specifically on the size in millimeters. Note that the Snellen chart typically has pupil measurements on the bottom. Use the “swinging flashlight” test to determine if an afferent pupillary defect is present. This would be the case in optic nerve pathology. A light source is moved back and forth from one eye to the other. A normal response in the eye not receiving the light would be to contract as the light is shined into the opposite eye. When it dilates after light is moved from that eye to the other, an afferent pupillary defect is presumed (see Figure 9.3).
Static and dynamic pupil characteristics in pseudoexfoliation syndrome and glaucoma
Published in Clinical and Experimental Optometry, 2020
Kemal Tekin, Hasan Kiziltoprak, Mehmet Ali Sekeroglu, Esat Yetkin, Serdar Bayraktar, Pelin Yilmazbas
All participants underwent a full ophthalmic assessment including best‐corrected visual acuity using the Snellen chart, gonioscopy with a Goldman three‐mirror lens, intraocular pressure measurement using a Goldmann applanation tonometer, slitlamp biomicroscopy, and dilated fundus examination. The refraction measurements were performed using the same automatic refractor‐keratometer device (RF‐K2 Full Auto Ref‐Keratometer; Canon, Tokyo, Japan) for each participant. The spherical equivalent (spherical component +1/2 cylinder component) was used to calculate the refractive error. In addition, eye movements were evaluated in all aspects of view and the clinical swinging flashlight test was performed to determine the afferent pupillary defects.
Development and Implementation of a Handheld Pupillometer for Detection of Optic Neuropathies
Published in Current Eye Research, 2021
Megha P. Bindiganavale, Heather E. Moss
The pupillary light response (PLR) is the constriction of the pupil in response to a light stimulus followed by subsequent dilation after the light stimulus is removed, and is an important component of the clinical neurological and ophthalmic exams.1,2 Reduced pupil constriction in response to light stimulation is a sign of optic nerve disease, and is captured clinically using the ‘swinging flashlight test’ to detect a relative afferent pupillary defect (rAPD). The rAPD is more sensitive to diagnosis of asymmetric optic nerve damage than visual acuity.3
Static and dynamic pupillometry data of healthy individuals
Published in Clinical and Experimental Optometry, 2018
Kemal Tekin, Mehmet Ali Sekeroglu, Hasan Kiziltoprak, Sibel Doguizi, Merve Inanc, Pelin Yilmazbas
Refraction measurements were performed on all participants using the same automatic refractor‐keratometer device (Canon RF‐K2 Full Auto Ref‐Keratometer, Tokyo, Japan). Red–green colour deficiency was assessed using Ishihara cards. Eye movements in all aspects of view were evaluated. The clinical swinging‐flashlight test was undertaken to determine afferent pupillary defects.