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Year : 2020  |  Volume : 32  |  Issue : 1  |  Page : 105-106

Simple and novel technique for pupillary light reflexes

Free Section, Aravind Eye Hospital, Madurai, Tamil Nadu, India

Date of Submission18-Feb-2020
Date of Acceptance20-Feb-2020
Date of Web Publication17-Apr-2020

Correspondence Address:
Dr. P R Aswin
Free Section, Aravind Eye Hospital, Madurai, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kjo.kjo_18_20

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How to cite this article:
Ravichandran V P, Aswin P R. Simple and novel technique for pupillary light reflexes. Kerala J Ophthalmol 2020;32:105-6

How to cite this URL:
Ravichandran V P, Aswin P R. Simple and novel technique for pupillary light reflexes. Kerala J Ophthalmol [serial online] 2020 [cited 2020 Aug 12];32:105-6. Available from: http://www.kjophthal.com/text.asp?2020/32/1/105/282651


At the outset, we would like to congratulate the Dr Rita Mary Tomy for the article titled Pupil: Assessment and diagnosis.[1] It was well written and managed to cover most of the important aspects of pupil examination and disorders of the pupil. We would like to provide an addition to the technique mentioned in the article on how to perform the direct and indirect light reflex test. With increasing use of slit-lamps, examination using torchlight and direct ophthalmoscope is becoming a lost art and yet extremely important in outreach camps where the ambient lighting may not always be ideal for pupillary examination. We believe the following technique to be a solution for this particular problem.

  Examination of Pupillary Action Top

The examination of pupil should be ideally performed in a dimly illuminated room.

Instruments required

  • Torch with 3–5 mm projection in its head end [Figure 1]
  • Direct ophthalmoscope.
Figure 1: Torch with 3–5 mm projection in its head end

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  Procedure Top

Both the patient and the doctor should be seated at the same level comfortably.

  Examination of Direct Reflex for the Left Eye Top

Close the patient's right eye with your left-hand thenar eminence touching the lateral wall of the nose. Hold the torch in your right hand and throw its light obliquely (about 60° angle) on the left eye and examine the pupillary action carefully [Figure 2].
Figure 2: Correct technique of occlusion of the right eye using the left thenar eminence and torch being held in the right hand

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Then, document the findings.

Closing the eye with your thumb or fingers is not advised as the torchlight can enter the eye [Figure 3] and [Figure 4].
Figure 3: Incorrect technique of occlusion using the thumb

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Figure 4: Incorrect technique of occlusion using fingers

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Switch hands to examine the right eye using the same technique.

  Examination of Indirect Reflex for the Left Eye Top

Hold the torch obliquely in your left hand over the right eye, touching the nose and hold the direct ophthalmoscope in your right hand, as shown in [Figure 5] and [Figure 6].
Figure 5: Checking the indirect light reflex using Direct ophthalmoscope which provides the dim illumination to observe the left pupil while the torch provides the bright illumination for the right eye

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Figure 6: Close up view showing how the Direct ophthalmoscope dimly illuminates the left pupil allowing for easy detection of the consensual reflex when stimulating the right eye

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Throw the ophthalmoscope's dim light through its largest aperture on the left eye obliquely so that the pupil can be seen dimly. Switch on the torch (to stimulate the right eye) and observe the changes in the left pupil. Note down the findings.

In the same way, right eye pupil can be examined and the findings to be noted down.

  Conclusion Top

We have observed that this particular technique to be simple, effective and it can be done even in the eye camps where despite the varied ambient lighting, the only requirements are a torch and direct ophthalmoscope. The ease of performing and training others is also a reason why we would like to recommend this technique for all postgraduates.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Tomy RM. Pupil: Assessment and diagnosis. Kerala J Ophthalmol 2019;31:167-71.  Back to cited text no. 1
  [Full text]  


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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