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A relative afferent pupillary defect (RAPD), also known as a Marcus Gunn pupil (after Robert Marcus Gunn), is a medical sign observed during the swinging-flashlight test [1] whereupon the patient's pupils excessively dilate when a bright light is swung from the unaffected eye to the affected eye. The affected eye still senses the light and ...
Marcus Gunn phenomenon is an autosomal dominant condition with incomplete penetrance, in which nursing infants will have rhythmic upward jerking of their upper eyelid. This condition is characterized as a synkinesis : when two or more muscles that are independently innervated have either simultaneous or coordinated movements.
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When the optic nerve is damaged, the sensory (afferent) stimulus sent to the midbrain is reduced. The pupil, responding less vigorously, dilates from its prior constricted state when the light is moved away from the unaffected eye and towards the affected eye. This response is a relative afferent pupillary defect (or Marcus Gunn pupil). [1]
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To settle the question of whether the AR pupil is of central or peripheral origin, it will be necessary to perform iris transillumination (or a magnified slit-lamp examination) in a substantial number of patients who have a pupillary light-near dissociation (with and without tonicity of the near reaction), perhaps in many parts of the world.