It is important to be able to differentiate whether a patient is complaining of decreased vision from an ocular problem such as cataract or from a defect of the optic nerve. It is due to damage inoptic nerve or severe retinal disease. A 57-year-old female presented to the Ophthalmology clinic at UIHC complaining bilateral central photopsias for the past two years.? Shine the flashlight at one eye noting the size of both pupils. No systemic disease other than multiple sclerosis that might be the cause of the optic neuritis. A relative afferent pupillary defect and a visual field defect in the affected eye. The left eye has perceived less light stimulus (a defect in the sensory or afferent pathway) then the opposite eye so the pupil dilates with the same light stimulus that caused constriction when the normal eye was stimulated. Full in both eyes; Pachymetry. She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate.? No previous corticosteroid treatment for optic neuritis or multiple sclerosis. Like other optic neuropathies, patients with TON may have decreased central visual acuity, decreased color vision, an afferent pupillary defect and/or visual field deficits. Sheathing of retinal veins and superficial retinal hemorrhages are rarely seen. Testing Fluorescein angiography No previous episodes of optic neuritis in the affected eye. One might also note optic disc edema, mild vitritis (usually posterior vitreous cells), mild anterior chamber flare, a relative afferent pupillary defect and an enlarged blind spot. No relative afferent pupillary defect in either eye; Extraocular Motility. It is important to remember that albeit rare, TON can be bilateral, so an afferent pupillary defect may … Enjoy the videos and music you love, upload original content, and share it all with friends, family, and the world on YouTube. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior … OD: 541 µm; OS: Unable to measure; External. Depending on their function, nerves are known as sensory, motor, or mixed. Epiphora in left eye, appears to be in discomfort; Slit Lamp Exam OS (Figure 1) Lid/lashes: Reactive ptosis; Conjunctiva/sclera: Diffuse 1+ … See Appendix 2-6 and see color plates. The swinging flashlight test is used to test for a relative afferent pupillary defect or a Marcus Gunn pupil. The swinging flashlight test is used to show a relative afferent pupillary defect or a Marcus Gunn pupil of the left eye. Relative Afferent Pupillary Defect (RAPD, Marcus Gunn Pupil) An RAPD is a defect in the direct response. a macroscopic cordlike structure of the body, comprising a collection of nerve fibers that convey impulses between a part of the central nervous system and some other body region. The dilatation produced by withdrawing the light from the normal eye outweighs the weak constriction produced by shining light on the diseased eye - this is why it is called a relative afferent pupillary defect. Relative afferent pupillary defect; Other names: Marcus Gunn pupil: The left optic nerve and the optic tracts.A Marcus Gunn pupil indicates an afferent defect, usually at the level of the retina or optic nerve.Moving a bright light from the unaffected eye to the affected eye would cause both eyes to dilate, because the ability to perceive the bright light is diminished. Swinging the flashlight back and forth between the two eyes identifies if one pupil has less light perception than the other.

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