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A consensual response is any reflex observed on one side of the body when the other side has been stimulated.. For example, if an individual's right eye is shielded from light, while light shines into the left eye, constriction of the right pupil will still occur (the consensual response), along with the left (the direct response).
A consensual pupillary reflex is response of a pupil to light that enters the contralateral (opposite) eye. Thus there are four types of pupillary light reflexes, based on this terminology of absolute laterality (left versus right) and relative laterality (same side versus opposite side, ipsilateral versus contralateral, direct versus consensual):
The pupillary reflex results in the pupil constricting (left) and dilating (right) These include the pupillary light reflex and accommodation reflex . Although the pupillary response , in which the pupil dilates or constricts due to light is not usually called a "reflex", it is still usually considered a part of this topic.
The Marcus Gunn pupil is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye. [3] In the swinging flashlight test, a light is alternately shone into the left and right eyes. A normal response would be equal constriction of both pupils, regardless of which eye the light is directed at.
When the optic nerve is damaged, the sensory (afferent) stimulus sent to the midbrain is reduced. The pupil, responding less vigorously, dilates from its prior constricted state when the light is moved away from the unaffected eye and towards the affected eye. This response is a relative afferent pupillary defect (or Marcus Gunn pupil). [1]
Pupillary light reflex is tested by having the patient stare into the distance as the examiner shines the penlight obliquely into each pupil. Pupillary constriction is tested for on the eye examined (direct response) and on the opposite eye (consensual response). The swinging flashlight test involves moving the light between the two pupils.
Pupillary response is a physiological response that varies the size of the pupil between 1.5 mm and 8 mm, [1] via the optic and oculomotor cranial nerve. A constriction response ( miosis ), [ 2 ] is the narrowing of the pupil, which may be caused by scleral buckles or drugs such as opiates / opioids or anti-hypertension medications.
AR pupils are now quite rare. A patient whose pupil "accommodates but does not react" almost always has a tonic pupil, not an AR pupil. In the 1950s, Loewenfeld distinguished between the two types of pupils by carefully observing the exact way in which the pupils constrict with near vision. [7] The near response in AR pupils is