Physical examination maneuver

Physical Exam

Pupillary Light Reaction

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Video coming September 2026

How to Perform

In dim lighting, ask the patient to fixate on a distant target. Shine a bright light from the side into one eye and watch that pupil constrict (direct response) while the opposite pupil constricts at the same time (consensual response); repeat for the other eye. Then perform the swinging-flashlight test, moving the light rhythmically from one eye to the other and watching each pupil as the light reaches it.

How to Interpret

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References

  • Brennan PM, Murray GD, Teasdale GM. Simplifying the use of prognostic information in traumatic brain injury. Part 1: The GCS-Pupils score: an extended index of clinical severity. J Neurosurg. 2018;128(6):1612-1620. PMID 29631516. DOI 10.3171/2017.12.JNS172780
  • Wang CH, Wu CY, Liu CC, Hsu TC, Liu MA, Wu MC, Tsai MS, Chang WT, Huang CH, Lee CC, Chen SC, Chen WJ. Neuroprognostic Accuracy of Quantitative Versus Standard Pupillary Light Reflex for Adult Postcardiac Arrest Patients: A Systematic Review and Meta-Analysis. Crit Care Med. 2021;49(10):1790-1799. PMID 34259437. DOI 10.1097/CCM.0000000000005045
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Related Chief Complaints

AgitationBalance ProblemsBlurred VisionCardiac ArrestCognitive DeclineColor Vision LossComaConfusionDecreased VisionDiarrheaDifficulty SpeakingDifficulty SwallowingDifficulty WalkingDifficulty with Daily TasksDilated PupilDizzinessDouble VisionDrooping EyelidDrowsinessDry MouthDry SkinExcessive SalivationEye MisalignmentEye Pain with MovementFacial DroopFacial WeaknessFeverFloatersFlushed SkinHallucinationsHead InjuryHeadacheLoss of ConsciousnessMemory LossMuscle TwitchingNumbness on One SidePalpitationsPersonality ChangePinpoint PupilsSeizureShooting Leg PainsShortness of BreathSlowed BreathingSlurred SpeechSmall PupilsSudden Vision LossSweatingTearingUnresponsivenessUnsteady GaitUrinary IncontinenceUrinary RetentionVertigoVision ChangesVision LossVomitingWeaknessWeakness on One Side

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