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Examination (pupils)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Pupils should be circular, central and equal in size. They should constrict to light and accommodation equally.

There are four steps in the examination of the pupils:

  • inspection:
    • look for irregularity, inequality in size or eccentricity

  • light reaction:
    • with one eye shielded from a pen torch beam observe the constriction of the illuminated pupil (the direct response) and the constriction in the shielded pupil (the consensual response)

  • swinging light test:
    • the pen torch beam should be passed rapidly from one eye to the other
    • the normal response is sustained constriction of both pupils
    • if one pupil dilates upon illumination there is an relative afferent pupillary defect (Marcus Gunn pupil) in that eye
    • this is a simple test of optic nerve function

  • accomodation reflex:
    • the patient is asked to look at a distant object and then at an object close to his face
    • both pupils should constrict and dilate again when distant gaze is resumed

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