Relative Afferent Pupillary Defect
Interactive Clinical Examples
Richmond Eye Associates

To observe these examples, move the mouse pointer over the pupil or each eye as if it were a light pen. In these cases, assume that the testing is being done in a dimly illuminated room.

Normal Pupillary Reaction, with Hippus:

Normal

In this case, there is no RAPD, as each pupil constricts equally with no redilation after the light is switched from pupil to pupil. Hippus is present, which is a normal fluctuation in pupillary size under steady illumination.
 




Relative Afferent Pupillary Defect,
Patient's Left Eye:

APD Left Eye

Clinical Example: A patient with optic neuritis affecting the left eye, and a normal right eye.
In this case, the left eye shows an initial weak constriction followed by dilation to a larger size. The right pupil constricts briskly.
 




Severe Relative Afferent Pupillary Defect,
Patient's Left Eye:

APD Left Eye

Clinical Example: A patient with a completely blind left eye following a central retinal artery occlusion.
The patient's left eye in this case shows no direct pupillary response, and an immediate full redilation to a larger size.
 




Reverse Relative Afferent Pupillary Defect,
Patient's Right Eye:

Reverse APD Right Eye

Clinical Example: This patient is status post multiple surgeries in the left eye for severe glaucoma and cataract, and the pupil is distorted and unreactive. The right eye has had an ischemic optic neuropathy with a severe loss of vision. In this case, the patient's RIGHT eye is the eye with the RAPD. The right pupil reacts briskly consensually to light in the left eye, but then redilates with direct illumination, indicating the presence of an RAPD.