Relative Afferent Pupilary Defect (RAPD)

Your Path

  • Relative afferent pupilary defect (RAPD)


  • Processes that affect afferents traveling with CN2 of one eye (can't be symmetric)
  • Autoimmune/inflammatory optic neuritis (e.g. MS); Ischemic optic neuritic (e.g. GCA); asymmetric glaucoma; tumors affecting optic nerve; trauma; retinal detachment; retinal infection


  • Vision in affected eye often impaired

Physical Exam Findings

  • EOMs nl
  • B pupils appear normal at baseline as afferents from non-affected eye are functional
  • Affected pupil w/impaired or absent repsonse to direct light
  • Unaffected pupil constricts normally to direct light
  • Swinging flashlight test→ light shined in normal eye→ pupil constricts normally
  • Swing flashlight to abnormal pupil→ gives appearance of affected pupil dilating in response to direct light→ swing back to normal eye and that pupil constricts