The ciliary muscles are innervated by the postganglionic parasympathetic axons (short ciliary nerve fibers) of the ciliary ganglion. retina and the optic tract fibers terminating on neurons in the hypothalamus and the, axons of the hypothalamic neurons that descend to the spinal cord to end on the, sympathetic preganglionic neurons in the lateral horn of spinal cord segments T1 to T3, which send their axons out the spinal cord to end on the, sympathetic neurons in the superior cervical ganglion, which send their, sympathetic postganglionic axons in the long ciliary nerve to the, sends corrective signals via the internal capsule and crus cerebri to the, is located immediately superior to the oculomotor nuclei, generates motor control signals that initiate the accommodation response. The nerves may redirect themselves through the greater superficial petrosal nerve to reach the lacrimal gland, causing ipsilateral tearing when the patient eats. The ocular reflexes are the simplest ocular motor responses. Reflex pathway with only one synapse between the sensory and motor neurons (ex: knee-jerk). Drag the labels to identify the five basic components of the pupillary light reflex pathway. Accommodation insufficiency is also less commonly associated with primary ocular disorders (e.g. The reflex can also occur in patients with entrapment after orbital floor fracture. The Parasympathetic nervous system predominately controls the pupillary light reflex. The accommodation reflex (or accommodation-convergence reflex) is a reflex action of the eye, in response to focusing on a near object, then looking at a distant object (and vice versa), comprising coordinated changes in vergence, lens shape (accommodation) and pupil size. Arch ophthalmol. :sphincter pupilae. Ocular motor responses include ocular reflexes and voluntary motor responses to visual and other stimuli. A patient is capable of pupillary constriction during accommodation but not in response to a light directed to either eye. S The superior salivatory nucleus in the pons gives off parasympathetic fibers that join other parasympathetic efferents from the salivatory nucleus[1]. Another method of testing for dilation lag is to take flash photographs at 5 seconds and 15 seconds to compare the difference in anisocoria; a greater than 0.4 mm difference in anisocoria between 5 seconds and 15 seconds indicates a positive test. Direct light reflex of right pupil involves the right optic nerve and right oculomotor nerve, which are both intact. https://www.aao.org/bcscsnippetdetail.aspx?id=767021d9-21a5-4b76-af43-49468a5bbd0c, https://www.aao.org/bcscsnippetdetail.aspx?id=3d31809c-9673-453c-a6c7-018c4540e6f9, https://eyewiki.org/w/index.php?title=Reflexes_and_the_Eye&oldid=83681. Since the pupil constriction velocity is approximately 3 times faster than (re)dilation velocity,[15] different step sizes in the numerical solver simulation must be used: where changes in head position Using this technique, it has been shown the pupil is smaller when a bright stimulus dominates awareness, relative to when a dark stimulus dominates awareness. Bronstein, AM. The pretectal nucleus projects crossed and uncrossed fibers to the ipsilateral and contralateral Edinger-Westphal nuclei, which are also located in the midbrain. These primary afferent fibers synapse on secondary afferent fibers in the spinal trigeminal nucleus, which send axons to reticular formation interneurons, which travel to the bilateral facial nuclei. The pupil is the space within the eye that permits light to project onto the retina. All rights reserved. The sensory losses would involve those sensations the cranial nerve normally conveys (e.g., taste from the anterior two thirds of the tongue and somatic sensations from the skin of the ear - if facial nerve is damaged). Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. Autonomic reflexes: activate cardiac muscles, activate smooth muscles, activate glands. -Shine the flashlight into the subject's left eye and measure the diameter of the left pupil. The pupillary light reflex two main parts: an afferent limb and an efferent limb. lens Section of the left short ciliary nerve or a benign lesion in the left ciliary ganglion will result in no direct response to light in the left eye and no consensual response in the left eye when light is directed on the right eye (a.k.a., tonic pupil). Observation: You observe that the patient, You conclude that his left eye's functional loss is, Pathway(s) affected: You conclude that structures in the following motor pathway have been affected. Short ciliary nerves leave the ciliary ganglion to innervate the constrictor muscle of the iris. All reflexes follow a reflex arc, which is made up of the components of a reflex. They control the tension on the zonules, which are attached to the elastic lens capsule at one end and anchored to the ciliary body at the other end (Figure 7.4). View Available Hint (S) Reset Help Optic Nerve Retinal Photoreceptors Sphincter Pupillae Midbrain Ciliary Ganglion Oculomotor Nervo Stimulus Receptor Sensory Integration Efectos Neuron Submit Oct 06 2022 10:45 AM and Is there a database for insurance claims? There will be a weakened or no reflex response and the muscle will be flaccid and may atrophy with time. Segments 3 and 8 form the efferent limb. 2. a large number of neurons and their associated synapses. are respectively the The Optic Nerve. Repeat this procedure on the opposite eye. Figure 7.13 Reflexes are rapid, predictable, and involuntary motor responses to stimuli. An RAPD is a defect in the direct pupillary response and usually suggests optic nerve disease or severe retinal disease. During the Dolls eye maneuver (oculocephalic reflex), the patient continuously fixates on an object while the examiner moves his or her head from side to side, and the examiner watches the patients eyes for catch-up saccades. The dark reflex dilates the pupil in response to dark[1]. These fibers run with gustatory afferents parallel to the facial nerve as the nervus intermedius and exit at the geniculate ganglion[12][13]. Was the final answer of the question wrong? If your pupils stay small even in dim light, it can be a sign that things in your eye arent working the way they should. Remaining segments where lesion may be located are segments 1, 3, and 5. CONTINUE SCROLLING OR CLICK HERE. Figure 7.6 Cook-Sather SD. Neuro-imaging, such as MRI scan, would be useful for confirmation of clinical findings. Sensory transduction is defined as _______. Dilation lag detection using infrared videography is the most sensitive diagnostic test for Horner syndrome[4]. The eye blink reflex is the simplest response and does not require the involvement of cortical structures. A transient RAPD can occur secondary to local anesthesia[4]. Ophthalmologic considerations: Dilation lag may occur in patients with a defect in the sympathetic innervation of the pupil, such as in Horner syndrome[4]. Gamlin, D.H. McDougal, in Encyclopedia of the Eye, 2010 Description Graduated from ENSAT (national agronomic school of Toulouse) in plant sciences in 2018, I pursued a CIFRE doctorate under contract with SunAgri and INRAE in Avignon between 2019 and 2022. Get it solved from our top experts within 48hrs! t In a normal response of the pupillary light reflex, shining a light into the eye causes constriction of its pupil. Side & Level of damage: As the pupillary light reflex loss. In general, ocular reflexes are consensual (i.e., the response is bilateral involving both eyes). Get it Now. The pupil is constricted, reducing the amount of light entering the eye. It is the response of the eye that is not being stimulated by light. Afferent pathway for pupillary constriction, lens accommodation, and convergence: Afferent input from the retina is sent to the lateral geniculate nucleus via the optic tract. The accommodation reflex (or accommodation-convergence reflex) is a reflex action of the eye, in response to focusing on a near object, then looking at a distant object (and vice versa), comprising coordinated changes in vergence, lens shape (accommodation) and pupil size. Pupillary Light Reflex Pathway, is a reflex that controls the diameter of the pupil, in response to the intensity (luminance) of light that falls on the retina of the eye, thereby assisting in adaptation to various levels of darkness and light, in addition to retinal sensitivity. where However, light touch of the right cornea will elicit a bilateral eye blink. 4 days ago. D. pretectal areas This answer is CORRECT! The most common complaint involving the accommodation response is its loss with aging (i.e., presbyopia). Symptoms. {\displaystyle \mathrm {d} M} Papillary muscle definition, one of the small bundles of muscles attached to the ventricle walls and to the chordae tendineae that tighten these tendons during ventricular contraction. Anatomically located in front of the lens, the pupil's size is controlled by the surrounding iris. Pupillary reflex is conceptually linked to the side (left or right) of the reacting pupil, and not to the side from which light stimulation originates. If the disc appears to be pale you may worry about pathology such as optic neuritis or glaucoma. They involve the action of few muscles and of well defined neural circuits. Once your account is created, you'll be logged-in to this account. Examination of the VOR via head rotation or caloric stimulation can be useful in the evaluation of unconscious patients, as tonic eye deviation indicates preserved pontine function[4]. a. reacts with water b. is red c. is shiny and silvery d. melts easily e. boils at 100 C^ { \circ } \mathrm { C }C f. is nonflammable g. has a low density h. tarnishes in moist air. d There are no other motor symptoms. The right consensual reflex is lost. Pathway: The ophthalmic division of the trigeminal nerve carries impulses to the main sensory nucleus of the trigeminal nerve. The lacrimatory reflex causes tear secretion in response to various stimuli: 1. physical and chemical stimuli to the cornea, conjunctiva and nasal mucosa, 2. bright light, 3. emotional upset, 4. vomiting, 5. coughing, 6. yawning[1]. Get plagiarism-free solution within 48 hours, Submit your documents and get free Plagiarism report, Your solution is just a click away! Andrefsky JC, Frank JI, Chyatte D. The ciliospinal reflex in pentobarbital coma. (allowing less light in), whereas lower intensity light causes the pupil to become larger Mydriasis, Sensitivity and Specificity Biostatistics Video Lecture, Vertical Mattress Suture Video Instruction, Pharmacokinetics Excretion Video Tutorial Made Easy, What Are Acute Pancreatitis Symptoms, Causes, Diagnosis, Treatment, Anti-aging Gene Therapy Injections Could Rewind Heart Age by 10 Years, The teen brain tunes out moms voice in favor of more unfamiliar voices, U.S. obesity epidemic The Role of Age, Sex and Race, Genetic Screening Lets Parents Pick the Healthiest Embryos, Study Shows Children Sleeping 10 Hours A Night Demonstrate More Success in Emotional Development, Learning, Surprising Benefits of Virovores: An Organism That Eats Viruses, What are Scoliosis Symptoms, Causes, Diagnosis and Treatment Options, Study Shows Children Sleeping 10 Hours A Night Demonstrate More Success in. Figure 7.7 In human nervous system: Reflex actions. is a constant that affects the constriction/dilation velocity and varies among individuals. T Ophthalmologic considerations: This reflex is sometimes observed during strabismus surgery[20]. Examination of his pupillary responses indicates a loss of the pupillary light reflex (no pupil constriction to light in either eye) but normal pupillary accommodation response (pupil constricts when the patient's eyes are directed from a distant object to one nearby). Observe the reaction of the patient's pupils to light directed in the left or right eye. An abnormal plantar reflex in an adult produces Babinski's sign, which indicates ________. Segments 4 and 7 form the efferent limb. The pupil dilates in the dark. Her left pupil appears dilated and is not reactive to light directed at either the left or right eye (Figure 7.10). An RAPD can occur due to downstream lesions in the pupillary light reflex pathway (such as in the optic tract or pretectal nuclei)[4]. However, the patient reports he can feel the cotton when it touches either eye. Pathway: Afferent fibers are carried by facial nerve. Postganglionic nerve fibers leave the ciliary ganglion to innervate the ciliary sphincter. The palpebral oculogyric reflex, or Bells reflex, refers to an upward and lateral deviation of the eyes during eyelid closure against resistance, and it is particularly prominent in patients with lower motor neuron facial paralysis and lagopthalmos (i.e. This building is one of the 12 Treasures of Spain. Were the solution steps not detailed enough? Blanc, VF, et al. The consensual light reflex occurs because both the optic and tectotegmental tracts carry fibers from both eyes. There will be an inability to close the denervated eyelid voluntarily and reflexively. This video will describe the mechanism for pupil constriction and dilation, list the autonomic reflex components, discuss the pupillary light reflex pathway, and demonstrate the procedure for testing the pupillary light reflex. Last Review 20 Oct 2020. is the pupil diameter measured in millimeters and 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 light reflex neural pathway on each side has an afferent limb and two efferent limbs. Light is the stimulus; impulses reach the brain via the optic nerve; and the response is conveyed to the pupillary musculature by autonomic nerves that supply the eye. The medial rectus attaches to the medial aspect of the eye and its contraction directs the eye nasally (adducts the eye). Right direct light reflex involves neural segments 2, 6, and 8. The patient, who appears with a bloodshot left eye, complains of an inability to close his left eye. Direct reflex of the right pupil is unaffected, The right afferent limb, right CN II, and the right efferent limb, right CN III, are both intact. His vision is normal when corrected for refractive errors. protecting the retina from damage by bright light. As with all experiments, it is important to establish a standard of comparison (control group). A loss of three or more lines of visual acuity is abnormal and indicative that the patients VOR is grossly reduced. T Pupillary Reflexes- There are several types of pupillary reflexes- the pupillary light reflex and the consensual reflex. Partial damage of the retina or optic nerve reduces the afferent component of the pupillary reflex circuit. , which can be described as Furthermore, segment 4 shares the same anatomical space in the midbrain as segment 3, therefore segment 4 will likely be affected if segment 3 is damaged. The horizontal gaze center coordinates signals to the abducens and oculomotor nuclei to reflexively induce slow movement of the eyes. Felten, DL, OBanion, MK, Maida, MS. Chapter 14: Sensory Systems. Afferent signals from the left eye cannot pass through the transected left optic nerve to reach the intact efferent limb on the left. Segment 1 is the afferent limb, which includes the retina and optic nerve. Ophthalmologic considerations: The OKN can be used to assess visual acuity in infants and children[15]. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Examples include retinal detachment, retinal ischemia, optic neuritis, severe glaucoma, trauma, and tumor of the optic nerve, among other causes. Section of the parasympathetic preganglionic (oculomotor nerve) or postganglionic (short ciliary nerve) innervation to one eye will result in a loss (motor) of both the direct and consensual pupillary light responses of the denervated eye. Left direct light reflex involves neural segments 1, 5, and 7. Hyperlacrimation may be due to excessive triggers of the tear reflex arc or from efferent parasympathetic fiber overstimulation. Get the patient to fix their eyes on a distant point to begin with, then to observe the pupils through a side illumination. C. Edinger-Westphal nucleus This answer is INCORRECT. Anisocoria is an inequality in the size of the pupils. Segment 2 is the afferent limb. Physical examination determines that touch, vibration, position and pain sensations are normal over the entire the body and face. eyelid muscle: the superior levator palpebrae. A direct pupillary reflex is pupillary response to light that enters the ipsilateral (same) eye. Abnormal pupillary function can indicate brainstem trauma, stroke, or drug abuse. Afferent pathway for pupillary constriction, lens accommodation, and convergence: Afferent input from the retina is sent to the lateral geniculate nucleus via the optic tract[2]. In supranuclear palsy, which can occur with Steele-Richardson syndrome, Parinauds syndrome, and double elevator palsy, patients cannot elevate their eyes but can do so on attempting the Bells phenomenon. . Anatomically, the afferent limb consists of the retina, the optic nerve, and the pretectal nucleus in the midbrain, at level of superior colliculus. The vomiting center in the medulla causes increased vagal output that leads to nausea and vomiting[19][21]. The afferent limb has nerve fibers running within the optic nerve (CN II). We use our eyes to monitor our external environment and depend on our ocular motor systems to protect and guide our eyes. function, pupil diameter If the pupillary dilation is due to the ciliospinal reflex, prolonged pupillary light stimulation should constrict the pupils[8] However, prolonged light stimulation cannot overcome pupillary dilation caused by bilateral third nerve palsies and midbrain dysfunction[8]. Bender MB. Light-near dissociation describes constriction of the pupils during the accommodative response that is stronger than the light response, and it is the primary feature of Argyll Robertson pupils in patients with neurosyphilis[4]. 2017;9(12):e2004. Analytical cookies are used to understand how visitors interact with the website. The location of the lesion is associated with the extent and type of vision deficit. {\displaystyle \mathrm {d} t} as well as parasympathetic preganglionic axons to the ciliary ganglion. It is the response of the eye that is being stimulated by light. A circular muscle called the sphincter pupillae accomplishes this task. The patient complains of pain in her left eye. 7.1).Afferent fibers of the retinal ganglion cells travel in the optic nerve and undergo hemidecussation at the chiasm before entering the optic tract. BELLS PHENOMENON: A STUDY OF 508 PATIENTS. Optic nerve is incorrect as section of one nerve would not obliterate the consensual response to stimulation of the contralesional eye. has not lost cutaneous sensation in the upper left face area, does not blink when his left cornea is touched, both reflex and voluntary motor functions, a branch of the nerve innervating the upper face, a lower motor neuron paralysis of the left orbicularis oculi, motor innervation on the left side (i.e., the symptoms are ipsilesional), responds with direct and consensual eye blink when his right cornea is touched, has lost cutaneous sensation in the upper left face area, a loss of the afferent limb of the eye blink response, the innervation of the left side (i.e., the symptoms are ipsilesional), a left pupil that does not react to light directly or consensually, a right pupil that reacts to light directly and consensually, not sensory (the right pupil reacts to light directed at the left eye), the pupillary light reflex pathway (Figure 7.11), does not involve eyelid or ocular motility, is limited to pupil constriction in the left eye, involves the motor innervation of the left iris sphincter, involves structures peripheral to the oculomotor nucleus (i.e., eye movement unaffected), involves the ciliary ganglion or the short ciliary nerve, is on the left side (i.e., the symptoms are ipsilesional), has not lost cutaneous sensation in the face area, cannot adduct his left eye (i.e., move it toward the nose), has a left dilated pupil that is non reactive to light in either eye, the pupillary/oculomotor pathway (Figure 7.11), is a lower motor neuron paralysis of the superior levator palpebrae, is a lower motor neuron paralysis of the medial, superior & inferior rectus muscles and inferior oblique muscles of the eye, is an autonomic disorder involving the axons of the Edinger-Westphal nucleus, respond when light is directed into either eye, has weaker direct and consensual responses to light directed in the left eye, the pupillary light reflex pathway (Figure 7.11), is in the afferent limb of the pupillary light response, produced a left pupillary afferent defect, do not respond when light is directed into the either of his eyes, motor (the pupillary light responses in both eyes are absent), higher-order motor (because he has a normal pupillary accommodation response), accommodation pathway have not been damaged (Figure 7.14), pupillary light reflex pathway have been damaged (Figure 7.11), does not involve the pupil accommodation response, involves only the pupillary light reflex response. Odd-numbered segments 1, 3, 5, and 7 are on the left. d Afferent pathway for pupillary constriction, lens accommodation, and convergence: Afferent input from the retina is sent to the lateral geniculate nucleus via the optic tract. Words may be used once, more than once, or not at all. t In the Argyll Robertson response, there is an absence of the pupillary light reflex with a normal pupillary accommodation response. The pupillary light reflex is an example of a(n) ________. The ciliary muscles, which control the position of the ciliary processes and the tension on the zonule, control the shape of the lens. Drag the images of the eyes to represent what damage to the right optic nerve would look like while shining light into each eye during pupillary reflex testing. These cookies will be stored in your browser only with your consent. These include arteritic (giant cell arteritis) and non-arteritic causes. Department of Neurobiology and Anatomy - Site webmaster: nba.webmaster@uth.tmc.edu, Instructional design and illustrations created through the Academic Technology. Lens accommodation: Lens accommodation increases the curvature of the lens, which increases its refractive (focusing) power. Part B - Pupillary Light Reflex Pathway Drag The Retinal photoreceptors, the optic nerve, the midbrain's integration centre, the occulomotor nerve, the motor neuron, and the sphincter pupilae all Posted The lines ending with an arrow indicate axons terminating in the structure at the tip of the arrow. Which of the following statements does not describe the procedure for testing the pupillary light reflex as shown in the video? Ciliary muscle dysfunction gradually improves over several months as injured axons regenerate and reinnervate the ciliary muscle, and the pupil becomes smaller over time. Free Nerve Endings in cornea that are afferent endings of the Trigeminal Nerve, Ganglion, Root & Spinal Trigeminal Tract*, Retina, Optic Nerve, Chiasm & Tracts and Brachium of Superior Colliculus*, Pretectal Areas of Midbrain (bilaterally to), Edinger-Westphal Nuclei & Oculomotor Nerves, Increases depth of focus of eye lens system, Visual System* including Visual Association Cortex. Touch, vibration, position and pain sensations are normal over the entire the body and face. It may be helpful to consider the Pupillary reflex as an 'Iris' reflex, as the iris sphincter and dilator muscles are what can be seen responding to ambient light. the best-known reflex is the pupillary light reflex. Which of the following does NOT describe graded potentials? Smooth muscles are activated in the pupillary light reflex. Drag and drop the correct terms on the left to complete the sentences. The visual system provides afferent input to ocular motor circuits that use visual stimuli to initiate and guide the motor responses. Irrigation of the external auditory meatus with ice water causes convection currents of the vestibular endolymph that displace the cupula in the semicircular canal, which induces tonic deviation of the eyes toward the stimulated ear[4]. When the damage is limited to the ciliary ganglion or the short ciliary nerve, eyelid and ocular mobility are unaffected. Consequently, a light directed in one eye elicits responses, pupillary constriction, in both eyes. When asked to rise his eyebrows, he can only elevate the right eyebrow. The oculorespiratory reflex revisited. Pathway for slow pursuit phase: Afferent signals from the retina are conveyed through the visual pathways to the occipital lobe, which sends impulses to the pontine horizontal gaze center[15]. Immediately following denervation injury, there is a dilated pupil that is unresponsive to light or near stimulation. Flash the light again and watch the opposite pupil constrict (consensual reflex). {\displaystyle T_{p}} Right pupillary reflex means reaction of the right pupil, whether light is shone into the left eye, right eye, or both eyes. When the left eye is stimulated by light, the right pupil constricts, because the afferent limb on the left and the efferent limb on the right are both intact. Reflex arcs are neural pathways composed of five basic components. Francis, IC, Loughhead, JA. toxin into the lacrimal gland. Pathway: Afferent pupillary fibers start at the retinal ganglion cell layer and then travel through the optic nerve, optic chiasm, and optic tract, join the brachium of the superior colliculus, and travel to the pretectal area of the midbrain, which sends fibers bilaterally to the efferent Edinger-Westphal nuclei of the oculomotor complex[2]. Testing the pupillary light reflex is easy to do and requires few tools. A patient who is suffering from the late stages of syphilis is sent to you for a neuro-ophthalmological work-up. Montoya FJ, Riddell CE, Caesar R, Hague S. Treatment of gustatory hyperlacrimation (crocodile tears) with injection of botulinum Section of the oculomotor nerve produces a non-reactive pupil in the ipsilesional side as well as other symptoms related to oculomotor nerve damage (e.g., ptosis and lateral strabismus). Ophthalmologic considerations: The ciliospinal reflex is absent in Horners syndrome due to loss of sympathetic input to the pupil[6] [7] Patients in a barbiturate induced coma may have a more easily elicited ciliospinal reflex and it may mimic a bilateral third cranial nerve palsy with dilated and unreactive pupils or midbrain compression with mid-positioned and unreactive pupils[8]. The pupil of the right eye constricts while shining a flashlight into the left eye. Which of the following structures of the eye is most responsible for absorbing light? What is the role of the pharyngotympanic tube? It does not store any personal data. He can smile, whistle and show his teeth, which indicates his lower facial muscles are functioning normally. {\displaystyle \mathrm {d} D} There are no other motor symptoms. PUPILLARY REFLEXES:- There are all total three pupillary reflexes - Light reflex, Near reflex and Psychosensory reflex. However, you may visit "Cookie Settings" to provide a controlled consent. The vestibulo-ocular reflex (VOR) allows for eye movements in the opposite direction of head movement to maintain steady gaze and prevent retinal image slip[4]. During accommodation three motor responses occur: convergence (medial rectus contracts to direct the eye nasally), pupil constriction (iris sphincter contracts to decrease the iris aperture) and lens accommodation (ciliary muscles contract to decrease tension on the zonules). The pupillary light reflex pathway involves the optic nerve and the oculomotor nerve and nuclei. glaucoma in children and young adults causing secondary atrophy of the ciliary body, metastases in the suprachoroidal space damaging the ciliary neural plexus, ocular trauma), neuromuscular disorders (e.g. If his acceleration is zero, display that fact. Which eye structure is primarily responsible for making the adjustments required to focus on objects both near and far? The pupillary light reflex is an example of a(n) Autonomic reflex. Endolymph in the semicircular canals moves when the head moves. If the right side of the neck is subjected to a painful stimulus, the right pupil dilates (increases in size 1-2mm from baseline). As the afferent information from each cornea is distributed bilaterally to facial motor neurons by the reticular formation interneurons, the eye blink response is consensual, that is, both eye lids will close to stimulation of the cornea of either eye. , If the reactive pupil constricts more with the direct response than with the consensual response, then the RAPD is in the unreactive pupil.
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