Management of moderate to severe marcus gunn jawwinking ptosis. This is a concise presentation for medical students especially from india. Donate us to help by your side to other medicos who cant afford costly books. Afferent pupillary defects, relative marcus gunn pupil request. The relative afferent pupillary defect is the most common abnormal pupillary finding, more common than all other pupillary defects combined. African the literature variably refers to the increased risk of glaucoma occurring in people of african descent. The marcus gunn robert marcus gunn syndrome or phenomenon was described by the author of the same name in 1883, in a case report published in the transactions of ophtalmologic society uk, according to citation of timothy w. This refers to people who trace their ancestry to africa, whether this be africanamericans, africancarribbeans, east africians, subsarharan africians or west africans. Afferent pupillary defect an overview sciencedirect topics. Figure 252 the swinging flashlight test shows a relative afferent pupil defect marcus gunn pupil in the left eye. Marcus gunn pupil describes the finding during the swingingflashlight test whereupon the patients pupils appear to dilate instead of constrict when the light swings from the unaffected good eye to the affected bad eye. You may see the test talk about rapd is the same as an apd which is also the same as a marcus gunn pupil. Rapd, relative afferent pupillary defect, marcus gunn pupil duration.
Relative afferent pupillary defect rapd or marcus gunn pupil 12. As the child becomes older they may avoid chewing on the. If the droopy eye lid covers over the pupil it can reduce the vision in the affected eye due to lack of visual stimulation. Inverse marcus gunn phenomenon is a rare congenital synkinetic movement presenting as eyelid drooping on jaw opening. Marcus gunn in 1904, it is clear from his report that the sign was generally known to clinicians of his time. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Head first web design pdf p l soni inorganic chemistry pdf 20 ways to draw everything blood, sweat, and pixels. Marcus gunn pupil, or relative afferent pupillary defect, is evident when one pupil paradoxically dilates to direct light when the flashlight swings between two eyes. It is also common in retrobulbar optic neuritis due to multiple sclerosis but only for 34 weeks, until the visual acuity begins to improve in 12weeks and may return to normal. A marcus gunn pupil, also known as a relative afferent pupillary defect rapd, is a nonspecific sign on physical examination that indicates partial optic nerve dysfunction. All structured data from the file and property namespaces is available under the creative commons cc0 license.
A focused history can help make a definitive diagnosis. We are all over the place this week, tackling topics from orthopedics to electrolyte abnormalities. Neonatal conjunctivitis comprises a number of entities, including chemical irritation caused by antimicrobial prophylaxis most common cause, infections acquired through direct contact between the neonate and the mothers cervix and vagina during delivery, and infections transmitted by crossinoculation in the neonatal period. Marcus gunn pupil relative afferent pupillary defect. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. The congress of neurological surgeons exists to enhance health and improve lives worldwide through the advancement of education and scientific exchange. Files are available under licenses specified on their description page. Mar 02, 2012 we use your linkedin profile and activity data to personalize ads and to show you more relevant ads. It is important to be able to differentiate whether a patient is complaining of decreased vision from an ocular problem such as cataract or from a defect of the optic nerve. Aug 17, 2004 for patients presenting with unilateral loss of vision, the possible cause, be it retinal or related to the optic nerve, can be pinpointed by the results of the swinging flashlight test, also known as the marcusgunn pupil test, which tests for defective afferent pupillary reflex. Significantly, the left pupil was minimally reactive. Other symptoms that may accompany marcus gunn pupil include blurry vision, vision loss. When candle present to the norm eye both pupils constrict.
Check out my new study guide study for the certified ophthalmic assistant exam. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced. Marcus gunn pupil or relative afferent pupillary defect rapd is a medical sign observed during the swingingflashlight test whereupon the patients pupils constrict less therefore appearing to dilate when a bright light is swung from the unaffected eye to the affected eye. Although the relative afferent pupillary defect was described by r. A marcus gunn pupil doesnt typically have symptoms of its own.
With the patient fixating on a distant target and background lighting dim, the pupils are equal and relatively large. A normal response would be equal constriction of both pupils, regardless of which eye the light is directed at. Afferent pupillary defect definition by babylons free. This seemingly paradoxical light reaction of the pupil was observed in retrobulbar neuritis by marcus gunn 1904, who attributed it to the consensual reaction of the pupil to darkness.
It is usually present at birth and may occur with other eye abnormalities such as strabismus or vision. The patient did not blink to threat on testing of his left eye. Pdf how to test for a relative afferent pupillary defect rapd. Conjunctivitis accounts for over 25% of all eye complaints seen. How to test for a relative afferent pupillary defect rapd. Marcus gunn pupil or marcus gunn sign is the term given to the relative afferent pupillary defect in which the affected pupil paradoxically dilates to the light stimulus. Aug 05, 2010 marcus gunn jaw winking phenomenon or syndrome pos duration. An afferent pupillary defect apd, or marcus gunn pupil results from a lesion of the optic nerve e. Marcus gunn 18501909 is most often remembered for his description of jawwinking. Marcus gunn pupil also referred to as relative afferent pupillary defect, or rapd shows unequal responses in the pupils when exposed to light.
Nhmrc guidelines international council of ophthalmology. Shining a flashlight into the right eye evokes equal, strong constriction of both pupils. Marcus gunn pupil is always unilateral and is seen in an optic nerve lesion anterior to the optic chiasm, such as retrobulbar optic neuritis or optic neuritis papillitis, and. Method a light is shone, first on one eye and then the other, with the opposite eye covered. The marcus gunn pupil in experimental tract lesions. Relative afferent pupillary defect a relative pupillary defect marcus gunn pupil is caused by an incomplete optic nerve lesion or severe. Further studies on the relationship between amblyopia and the stilescrawford effect. There are several simple ways to uncover the pupil hyporeactivity, but to gunn 1 goes the credit of popularizing the phenomenon that is often termed the marcus gunn pupil or the marcus gunn pupillary sign. Rapid ophthalmology pdf free download medicos ideas. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. This left relative afferent pupillary defect rapd persisted throughout his. Sep 01, 2015 marcus gunn phenomenon is a rare condition characterized by movement of the upper eyelid in a rapid rising motion a wink each time the jaw moves.
Scribd is the worlds largest social reading and publishing site. Relative afferent pupillary defect in optic tract hemianopias. The first page of the pdf of this article appears above. Ppt pupillary pathways powerpoint presentation free to.
Marcus gunn phenomenon is an autosomal dominant condition with incomplete penetrance, in which nursing infants will have rhythmic upward jerking of their upper eyelid. Publications home of jama and the specialty journals of the. The wink phenomenon may be elicited by opening the mouth, thrusting the jaw to the side, jaw protrusion, chewing, smiling, or sucking. How to test for a relative afferent pupillary defect rapd ncbi. Aug 22, 2019 download our medical book series which include harrisons, oxford, rapid, netter, lecture notes, churchills, at a glance, 100 cases and many more. Comments on the paradoxic pupillary dilatation in optic.
In a very dark room, shine a penlight in the left eye. Pupillary signs see table 12 relative afferent pupillary defect rapd, marcus gunn pupil see ophthalmology chapter a failure of direct pupillary responses to light a sign of damage to the afferent portion of the pupillary reflex arc cnii optic nerve optic neuritis, ischemia, compression optic chiasm severe compression, e. Get a printable copy pdf file of the complete article 197k, or click on a page image below to browse page by page. Cn2 governs sight, and is thus stimulated by light. It is important to remember that there is no anisocoria in. The marcus gunn pupil is a relative afferent pupillary defect indicating a decreased pupillary response to light in the affected eye. Pupillary escape in disease of the retina or optic nerve. Kitaoka a, ashida h 2003 phenomenal characteristics of the peripheral drift illusion. Sir, the marcus gunn syndrome, described by gunn in 1883, is one of the more common congenital oculofacial synkineses, and accounts for approximately 5% of all congenital ptosis. A relative afferent pupillary defect rapd is a clinical sign used to detect a lesiondefect in the pupil pathway on the afferent side. Oct 25, 2014 pupil anomalies 1argyll robertson pupil 2reverse argryll robertson pupil 3adies tonic pupil 4horners syndrome 5marcus gunn pupil rapd 6amaurotic pupil 7hutchinsons pupil 8paradoxical pupil 9 hippus 7.
Mar 01, 2006 the concept of a relative afferent pupillary defect rapd was first introduced by hirschberg in 1884 when he diagnosed a young woman with retrobulbar neuritis. Gunn pupil marcus gunn pupil a change in the pupillary reflex, caused by unilateral optic nerve or retinal disease. The swinging light test is used to detect a relative afferent pupil defect rapd. At the age of 5 weeks, when the infant was suckling, it was noted that the ptosed lid nearly went up out of sight with each movement of the jaw. Marcus gunn pupil markus gun, relative afferent pupillary defect. Marcusgunn pupil or rapd is a nonspecific feature denoting optic neuropathy. A brand new title in the rapid series, providing a concise, structured approach for students preparing for ophthalmology examinations. It may indicate dynamic anisocoria or a marcus gunn pupil, a relative afferent pupillary defect rapd. Telephone email address city, state interrogatorio. When candle is swinging to affect eye both pupils paradoxically dialate. Afferent pupillary defect english to english translation. Links to pubmed are also available for selected references.
Jan 04, 2017 pupillary dilatation is controlled by the sympathetic system and is efferent only. Abnormal pupils i relative afferent pupillary defect marcus gunn pupil a introduction. Important questions to ask in the history are shown in table 2. The payee may view, download, andor print the article for hisher personal, scholarly, research, and. Afferent pupillary defect free definitions by babylon. Winner of the standing ovation award for best powerpoint templates from presentations magazine.
Relative afferent pupillary defect rapd is a medical sign observed during the. A painful red eye answer 1 the differential diagnosis of a unilateral red eye is shown in table 1. Marcus gunn pupil definition of marcus gunn pupil by. Rapd relative afferent pupillary defect springerlink. Pupiliary pathway visual system organ anatomy scribd. Then, there are changes in color vision, and disorders of the visual 2 zoric lepsa, stojicevic snezana, bukumiric zoran test on. Injury to the optic nerve, if partial, may present as a marcus gunn pupil. Toxic pupil in neuromuscular blockde adies tonic pupil due to ciliary gangilion block paralytic pupil incn3 nerve palsy argyll robertson pupil pretectal nucleus lesion marcus gunn pupiloptic nerve involvement rotating snake illusion. In this video, we are going to see about marcus gunn pupil or rapd. Only one electromyographic study has been reported in this condition. Request pdf on jan 1, 2015, eileen choudhury and others published afferent pupillary defects, relative marcus gunn pupil find, read and cite all the. During a swinging flashlight test, the right pupil constricted from 4 mm to 2 mm, while the left remained at 5 mm. Marcus gunn pupil plural marcus gunn pupils a pupil of the eye that exhibits unusually little constriction when a bright light is swung from the unaffected eye to the affected eye. Marcus gunn phenomenon is a rare condition characterized by movement of the upper eyelid in a rapid rising motion a wink each time the jaw moves.
Pupil anomalies and disorders shiva ppt linkedin slideshare. Llight reaction to light is tested by marcus gunn aka apdafferent pupillary defect aaccommodate pupils change size when the look up close. Marcus gunn pupil an overview sciencedirect topics. Find it by a swinging flashlight test a medical term. Marcus gunn phenomenon, is an autosomal dominant condition with incomplete penetrance, in which nursing infants will have rhythmic upward jerking of their upper eyelid. While you are downloading pdf s link in bottom straight in your. Information on how to subscribe to neurology and neurology. Harrisons principles of internal medicine, 16th edition. Thank you for your interest in spreading the word about the bmj. Steven mcgee md, in evidencebased physical diagnosis fourth edition, 2018. Relative afferent pupillary defect rapd marcus gunn pupil or relative afferent pupillary defect rapd presents as a disturbance to the consensual light reflex. The marcus gunn pupil implies paradoxical pupillary dilation when a light is swung between the intact and the.
Marcus gunn jawwinking is thought to be a form of synkinetic ptosis. However, it was not until 1946 that kestenbaum popularized and quantified the concept and incorrectly credited marcus gunn with the discovery. The payee may view, download, andor print the article for hisher personal, scholarly, research. Marcus gunn pupil see ophthalmology chapter a failure of direct pupillary responses to light a sign of damage to the afferent portion of the pupillary reflex arc cnii optic nerve optic neuritis, ischemia, compression optic chiasm severe compression, e. Pdf on jan 1, 2016, david c broadway and others published how to test for a. Full text full text is available as a scanned copy of the original print version. During sleep the pupils are partially constricted but still react to light. Relative afferent pupillary defect rapd, marcus gunn pupil an rapd is a defect in the direct response.