Marcus gunn pupil, or relative afferent pupillary defect, is evident when one pupil paradoxically dilates to direct light when the flashlight swings between two eyes. Injury to the optic nerve, if partial, may present as a marcus gunn pupil. With the patient fixating on a distant target and background lighting dim, the pupils are equal and relatively large. An aberrant connection appears to exist between the motor branches of the trigeminal nerve cn v3 innervating the external pterygoid muscle and the fibers of the superior division of the oculomotor nerve cn iii that innervate the levator superioris muscle of the upper eyelid. Sir, the marcus gunn syndrome, described by gunn in 1883, is one of the more common congenital oculofacial synkineses, and accounts for approximately 5% of all congenital ptosis.
Mar 02, 2012 we use your linkedin profile and activity data to personalize ads and to show you more relevant ads. Information on how to subscribe to neurology and neurology. It is usually present at birth and may occur with other eye abnormalities such as strabismus or vision. Ppt pupillary pathways powerpoint presentation free to. Rapd, relative afferent pupillary defect, marcus gunn pupil duration.
An afferent pupillary defect apd, or marcus gunn pupil results from a lesion of the optic nerve e. Relative afferent pupillary defect rapd, marcus gunn pupil an rapd is a defect in the direct response. Nhmrc guidelines international council of ophthalmology. Method a light is shone, first on one eye and then the other, with the opposite eye covered. Rapid ophthalmology pdf free download medicos ideas. Afferent pupillary defect english to english translation. Harrisons principles of internal medicine, 16th edition. Also known as a marcusgunn pupil, the afferent pupillary defect is due to dysfunction of cranial nerve 2 optic nerve. The relative afferent pupillary defect is the most common abnormal pupillary finding, more common than all other pupillary defects combined.
This refers to people who trace their ancestry to africa, whether this be africanamericans, africancarribbeans, east africians, subsarharan africians or west africans. During sleep the pupils are partially constricted but still react to light. Scribd is the worlds largest social reading and publishing site. It is important to remember that there is no anisocoria in. In the swinging flashlight test, a light is alternately shone into the left and right eyes. Oct 25, 2014 pupil anomalies 1argyll robertson pupil 2reverse argryll robertson pupil 3adies tonic pupil 4horners syndrome 5marcus gunn pupil rapd 6amaurotic pupil 7hutchinsons pupil 8paradoxical pupil 9 hippus 7. Marcus gunn pupil plural marcus gunn pupils a pupil of the eye that exhibits unusually little constriction when a bright light is swung from the unaffected eye to the affected eye. The pathway begins in the cortex, which exerts a modulatory effect on constriction which is lost during drowsiness and sleep but increased during intense concentration and arousal. Steven mcgee md, in evidencebased physical diagnosis fourth edition, 2018. The payee may view, download, andor print the article for hisher personal, scholarly, research. Check out my new study guide study for the certified ophthalmic assistant exam.
Kitaoka a, ashida h 2003 phenomenal characteristics of the peripheral drift illusion. Telephone email address city, state interrogatorio. In a very dark room, shine a penlight in the left eye. Conjunctivitis accounts for over 25% of all eye complaints seen.
Other symptoms that may accompany marcus gunn pupil include blurry vision, vision loss. When candle present to the norm eye both pupils constrict. Donate us to help by your side to other medicos who cant afford costly books. This seemingly paradoxical light reaction of the pupil was observed in retrobulbar neuritis by marcus gunn 1904, who attributed it to the consensual reaction of the pupil to darkness. Pdf how to test for a relative afferent pupillary defect.
It may indicate dynamic anisocoria or a marcus gunn pupil, a relative afferent pupillary defect rapd. Thank you for your interest in spreading the word about the bmj. If the droopy eye lid covers over the pupil it can reduce the vision in the affected eye due to lack of visual stimulation. The congress of neurological surgeons exists to enhance health and improve lives worldwide through the advancement of education and scientific exchange. Llight reaction to light is tested by marcus gunn aka apdafferent pupillary defect aaccommodate pupils change size when the look up close. This left relative afferent pupillary defect rapd persisted throughout his. Ophthalmology department, centro hospitalar sao joao, porto, portugal a 17yearold healthy boy is admitted to the emergency department with suddenonset decreased vision in his left eye. Find it by a swinging flashlight test a medical term.
Relative afferent pupillary defect rapd is a medical sign observed during the. 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. Neonatal conjunctivitis comprises a number of entities, including chemical irritation caused by antimicrobial prophylaxis most common cause, infections acquired through direct contact between the neonate and the mothers cervix and vagina during delivery, and infections transmitted by crossinoculation in the neonatal period. The marcus gunn pupil in experimental tract lesions. While you are downloading pdf s link in bottom straight in your. Pupillary escape in disease of the retina or optic nerve. Marcus gunn 18501909 is most often remembered for his description of jawwinking.
You may see the test talk about rapd is the same as an apd which is also the same as a marcus gunn pupil. It is also common in retrobulbar optic neuritis due to multiple sclerosis but only for 34 weeks, until the visual acuity begins to improve in 12weeks and may return to normal. Mar 01, 2006 the concept of a relative afferent pupillary defect rapd was first introduced by hirschberg in 1884 when he diagnosed a young woman with retrobulbar neuritis. African the literature variably refers to the increased risk of glaucoma occurring in people of african descent. Marcusgunn pupil or rapd is a nonspecific feature denoting optic neuropathy. Significantly, the left pupil was minimally reactive.
Marcus gunn jawwinking is thought to be a form of synkinetic ptosis. A painful red eye answer 1 the differential diagnosis of a unilateral red eye is shown in table 1. Marcus gunn pupil or relative afferent pupillary defect rapd is a medical sign observed during the swingingflashlight test whereupon the patients pupils constrict less therefore appearing to dilate when a bright light is swung from the unaffected eye to the affected eye. Afferent pupillary defects, relative marcus gunn pupil request.
Toxic pupil in neuromuscular blockde adies tonic pupil due to ciliary gangilion block paralytic pupil incn3 nerve palsy argyll robertson pupil pretectal nucleus lesion marcus gunn pupiloptic nerve involvement rotating snake illusion. Then, there are changes in color vision, and disorders of the visual 2 zoric lepsa, stojicevic snezana, bukumiric zoran test on. Afferent pupillary defect definition by babylons free. How to test for a relative afferent pupillary defect rapd. Afferent pupillary defect free definitions by babylon. Marcus gunn pupil an overview sciencedirect topics. However, it was not until 1946 that kestenbaum popularized and quantified the concept and incorrectly credited marcus gunn with the discovery. Rapd relative afferent pupillary defect springerlink. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Jan, 2019 all answers are confirmed from online nbme 1 f its marcus gunn pupil,you should know that its decreased bilateral pupillary const. Relative afferent pupillary defect rapd or marcus gunn pupil 12.
There are several simple ways to uncover the pupil hyporeactivity, but to gunn 1 goes the credit of popularizing the phenomenon that is often termed the marcus gunn pupil or the marcus gunn pupillary sign. The payee may view, download, andor print the article for hisher personal, scholarly, research, and. Pdf how to test for a relative afferent pupillary defect rapd. A marcus gunn pupil doesnt typically have symptoms of its own. Comments on the paradoxic pupillary dilatation in optic. Marcus gunn pupil describes the finding during the swingingflashlight test whereupon the patients pupils appear to dilate instead of constrict when the light swings from the unaffected good eye to the affected bad eye. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Pdf on jan 1, 2016, david c broadway and others published how to test for a. Marcus gunn pupil also referred to as relative afferent pupillary defect, or rapd shows unequal responses in the pupils when exposed to light. All structured data from the file and property namespaces is available under the creative commons cc0 license.
In this video, we are going to see about marcus gunn pupil or rapd. At the age of 5 weeks, when the infant was suckling, it was noted that the ptosed lid nearly went up out of sight with each movement of the jaw. A focused history can help make a definitive diagnosis. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Marcus gunn pupil markus gun, relative afferent pupillary defect. The marcus gunn robert marcus gunn syndrome or phenomenon was described by the author of the same name in 1883, in a case report published in the transactions of ophtalmologic society uk, according to citation of timothy w. Full text full text is available as a scanned copy of the original print version. Request pdf on jan 1, 2015, eileen choudhury and others published afferent pupillary defects, relative marcus gunn pupil find, read and cite all the.
Sep 01, 2015 marcus gunn phenomenon is a rare condition characterized by movement of the upper eyelid in a rapid rising motion a wink each time the jaw moves. Cn2 governs sight, and is thus stimulated by light. Management of moderate to severe marcus gunn jawwinking ptosis. Marcus gunn,1 in 1883, reported a case of congenital ptosis with peculiar associated movements of the affected lid in a girl of 17. Aug 22, 2019 download our medical book series which include harrisons, oxford, rapid, netter, lecture notes, churchills, at a glance, 100 cases and many more. Head first web design pdf p l soni inorganic chemistry pdf 20 ways to draw everything blood, sweat, and pixels. The marcus gunn pupil is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye. Pupiliary pathway visual system organ anatomy scribd. The patient did not blink to threat on testing of his left eye. Aug 05, 2010 marcus gunn jaw winking phenomenon or syndrome pos duration. Marcus gunn phenomenon is an autosomal dominant condition with incomplete penetrance, in which nursing infants will have rhythmic upward jerking of their upper eyelid.
It is due to damage inoptic nerve or severe retinal disease. Relative afferent pupillary defect a relative pupillary defect marcus gunn pupil is caused by an incomplete optic nerve lesion or severe. Jan 04, 2017 pupillary dilatation is controlled by the sympathetic system and is efferent only. When candle is swinging to affect eye both pupils paradoxically dialate. Although the relative afferent pupillary defect was described by r. Further studies on the relationship between amblyopia and the stilescrawford effect. How to test for a relative afferent pupillary defect rapd ncbi. Marcus gunn phenomenon, is an autosomal dominant condition with incomplete penetrance, in which nursing infants will have rhythmic upward jerking of their upper eyelid. Shining a flashlight into the right eye evokes equal, strong constriction of both pupils. Files are available under licenses specified on their description page. The direct response of the pupil to light can be compared to the contralateral consensual response by swinging the light stimulus between the two pupils. Relative afferent pupillary defect rapd marcus gunn pupil or relative afferent pupillary defect rapd presents as a disturbance to the consensual light reflex.
Links to pubmed are also available for selected references. During a swinging flashlight test, the right pupil constricted from 4 mm to 2 mm, while the left remained at 5 mm. As the child becomes older they may avoid chewing on the. Abnormal pupils i relative afferent pupillary defect marcus gunn pupil a introduction. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. A brand new title in the rapid series, providing a concise, structured approach for students preparing for ophthalmology examinations. Marcus gunn pupil or marcus gunn sign is the term given to the relative afferent pupillary defect in which the affected pupil paradoxically dilates to the light stimulus. Get a printable copy pdf file of the complete article 197k, or click on a page image below to browse page by page. Aug 17, 2004 for patients presenting with unilateral loss of vision, the possible cause, be it retinal or related to the optic nerve, can be pinpointed by the results of the swinging flashlight test, also known as the marcusgunn pupil test, which tests for defective afferent pupillary reflex. Marcus gunn pupil see ophthalmology chapter a failure of direct pupillary responses to light a sign of damage to the afferent portion of the pupillary reflex arc cnii optic nerve optic neuritis, ischemia, compression optic chiasm severe compression, e. We are all over the place this week, tackling topics from orthopedics to electrolyte abnormalities. The swinging light test is used to detect a relative afferent pupil defect rapd.
Afferent pupillary defect an overview sciencedirect topics. Only one electromyographic study has been reported in this condition. This is a concise presentation for medical students especially from india. A relative afferent pupillary defect rapd is a clinical sign used to detect a lesiondefect in the pupil pathway on the afferent side. The marcus gunn pupil implies paradoxical pupillary dilation when a light is swung between the intact and the. Marcus gunn pupil definition of marcus gunn pupil by. Marcus gunn pupil relative afferent pupillary defect. The first page of the pdf of this article appears above. Relative afferent pupillary defect in optic tract hemianopias. Important questions to ask in the history are shown in table 2. Figure 252 the swinging flashlight test shows a relative afferent pupil defect marcus gunn pupil in the left eye.
Pupil anomalies and disorders shiva ppt linkedin slideshare. Marcus gunn in 1904, it is clear from his report that the sign was generally known to clinicians of his time. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced. Pupillary signs see table 12 relative afferent pupillary defect rapd, marcus gunn pupil see ophthalmology chapter a failure of direct pupillary responses to light a sign of damage to the afferent portion of the pupillary reflex arc cnii optic nerve optic neuritis, ischemia, compression optic chiasm severe compression, e. Marcus gunn phenomenon is a rare condition characterized by movement of the upper eyelid in a rapid rising motion a wink each time the jaw moves. The wink phenomenon may be elicited by opening the mouth, thrusting the jaw to the side, jaw protrusion, chewing, smiling, or sucking. Inverse marcus gunn phenomenon is a rare congenital synkinetic movement presenting as eyelid drooping on jaw opening. Test for defective afferent pupillary response cmaj. A normal response would be equal constriction of both pupils, regardless of which eye the light is directed at. Marcus gunn pupil is always unilateral and is seen in an optic nerve lesion anterior to the optic chiasm, such as retrobulbar optic neuritis or optic neuritis papillitis, and.
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