pupillary assessment

Question 1

what can pupillary assessment tell us about the eyes?

Answer 1

tells us the integrity and function of the iris, optic nerve, posterior visual pathways, and the third and sympathetic nerves to the eye

it is a compulsory preliminary test under OOB

Question 2

what does PERRLA MG stand for?

Answer 2

P = Pupils

E = Equal

R = Round

R = Reactive to

L = Light &

A = Accommodation

MG = Marcus Gunn/ relative afferent pupillary defect (RAPD)

Question 3

DIrect and consensual reflex and swinging flashlight assessment set up?

Answer 3

Remove spectacles (if applicable)
Dim the room lights

Question 4

DIrect and consensual reflex assessment instructions?

Answer 4

a) “I will be checking your eye’s response to light”

b) “Please look at @ the letter or spotlight (DISTANT TARGET), and do not look into my shining light at all times”

Question 5

explain the steps involved in direct and consensual reflex

Answer 5

1. Shine a penlight into the right pupil from the inferior temporal side from a distance of 5 to 10 cm.
2. Observe the extent and speed of constriction of the right pupil (direct light reflex) and left pupil (consensual reflex).
3. Check this several times because dramatic fatigue can occur in an abnormal eye that at first shows a normal response.
4. The reactivity is based on the response speed of the pupil:
5. repeat on left pupil

Question 6

what is the grading for response speed of pupil?

Answer 6

0: No response
1+: small, visible
2+: small, slow response
3+: moderate response
4+: brisk, large response

Question 7

explain the steps involved in swinging flashlight?

Answer 7

1. Shine a penlight or direct ophthalmoscope into the right eye from below the patient’s eyes from a distance of 5 to 10 cm.
2. Pause for 2 to 3 seconds and then quickly switch the light to shine into the left eye.
3. Repeatedly alternate between the two eyes, pausing for 2 to 3 seconds on each eye, and look for any change in pupil size as the light is alternated.
4. Observe the EYE with the LIGHT shining on.

Question 8

what is a normal response of swinging flashlight test?

Answer 8

A normal response is that both pupils will constrict as the penlight is shone in one eye. Moving to the other eye will maintain the constriction.

A slight hippus or bilateral dilation is normal.

Question 9

what is an abnormal RAPD response?

Answer 9

An eye with an RAPD will dilate as the light is turned upon it from the good eye.

Question 10

when is near reflex assessment carried out?

Answer 10

This need be measured only if the light responses are abnormal or sluggish.

Question 11

what are the steps in volved in near reflex assessment?

Answer 11

1. Ask the patient to remain fixating a letter or spotlight on the distance chart.
2. Ask the patient to then look at a NEAR target, such as the patient’s own thumb, about 15 cm from his or her eyes.
3. Observe the extent and speed of pupillary constriction as the patient changes fixation from distance to near.