Diagnosis of pupillary anomalies

Lesions of the afferent, intercalated, efferent (parasympathetic), and cervical sympathetic arms of the pupillary pathway each tend to produce rather distinctive clinical signs. Sophisticated equipment generally is not needed to define the probable basis for anisocoria and/or disordered pupillary function. Diagnosis of the more common anomalies of the pupil usually can be made from observations obtained using only a penlight, occluder, slit lamp biomicroscope, and a few diagnostic pharmaceutical agents. This paper has been written as a guide to recognition of pupillary signs and as an aid to the practitioner who must differentiate among those that mandate immediate referral, those which require careful analysis on a less urgent basis, and those that can be regarded, for all practical purposes, as benign.