Determining and quantitating the relative afferent pupillary defect
in a patient in which the left eye is dilated and fixed because of
an efferent defect
Determining and quantitating the
relative afferent pupillary defect (RAPD) in a patient in which the
left eye is dilated and fixed because of an efferent defect. The
right eye is illuminated by a side light in darkness during the
alternating light test, as described in . There is less consensual
pupillary contraction of the right (working) pupil when the left
eye is illuminated, indicating an RAPD in the left eye. The RAPD
can still be quantitated by placing neutral‐density
filters in front of the right eye (which has the better afferent
input) until the direct and consensual responses of the right pupil
are equal. In this case, the 0.6–log unit filter balances the
responses. Therefore, the patient should be recorded as having a
0.6–log unit RAPD in the left eye, with an efferent defect in the
left eye. In practice, quantitating an RAPD in the presence of an
efferent defect is difficult without an assistant because three
hands are needed: one for the side light, one for the neutral
density filter, and one for the alternating test light.
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