Pupil diameter can be affected by parasympathomimetic agents and adrenergic agonists (see Chapter 12). A relative afferent pupillary defect (RAPD) is often seen in the presence of asymmetric glaucoma damage; however, if an RAPD cannot be reconciled with the overall clinical picture of glaucoma, the presence of a nonglaucomatous optic neuropathy must be ruled out. In some clinical situations, it is not possible to assess the pupils objectively for the presence of an RAPD, and a subjective comparison between the eyes of the perceived brightness of a test light may be helpful.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.