![]() 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 the one eye to the fellow eye. 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 of both eyes equally. No 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.
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