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PURPOSE To assess the afferent and efferent neurological pathways responsible for pillary function．
EQUIPMENT
·Penlight or transilluminator．
·Distant fixation target(eg．20/400 E)．
SET-UP
·Use ambient illumination that is as dim as possible，but permits a clear view of both of the patient’s pils．
·Position yourself within 25 cm of the patient，but not in his line of sight (ie，off to one side，sitting or standing)．
·Instruct the patient to remove his spectacles．
STEP-BY-STEP PROCEDURE
1．Instruct the patient to look at the distant target．
2．Shine the light into his right eye and observe the size and the speed of the pillary constriction in this eye．
3．Repeat step 2 two times．
4．Shine the light into the right eye and observe the size and the speed of the pillary constriction in the left eye．
5．Repeat step 4 two times．
6．Repeat steps 2 through 5 shining the light into the left eye again observing the direct and consensual responses of the appropriate pils．
7．Swinging Flashlight Test：Move the light between the eyes rapidly．leaving it on each eye for 3 to 5 seconds．Observe the response(dilation or constriction)and the size of each pil at the moment when the light first arrives there and during the 3 to 5 second observation period．Be sure to shine an equal intensity of light into each eye．
8．The swinging flashlight test should be repeated for 2 or 3 complete cycles．
9．Throughout the test，judge the roundness of each pil．
10．If the pils are unequal in size, perform the dim-bright pillary test(see Chapter 8)．
11．If either or both pils fail to respond directly or consensually，or if their responses are sluggish．test the accommodative response of the pil(see Chapter 8)．
RECORDING
·If all the pillary responses are normal, write PERRL no MG (Pils Equal Round Responsive to Light；no Marcus Gunn response)．Record only those that apply, omitting the others．
·Separately describe abnormalities，such as inequality of size，shape，or rate of response(see also，Recording, under dim-bright pillary test)．
·If pillary escape is observed on the swinging flashlight test, record +MG(positive Marcus Gunn)or +RAPD(positive relative afferent pillary defect)，followed by the affected eye．
EXAMPLES
PERRL, +MG OS
PRRL, no MG, OD＞OS by 1 mm in dim and bright
0D：RRL D no RAPD
OS：irregular，sluggish D and C
EXPECTED FINDINGS
·PERRL，no RAPD |
