A wealth of information can be learned from examination of the pupils. An attempt should first be made to determine whether the pupils react to light and, if so, how briskly? A brisk constriction to light usually indicates good ocular and optic nerve function. A sluggish response, or no response at all, implies retina, optic nerve, or third nerve dysfunction. This assessment of pupil response to light can be helpful in localizing the site of visual loss, which is especially helpful in the child with possible cortical visual impairment (Fig. 2-3). Brisk pupillary reactions in a child with profound visual loss indicate a cortical etiology (Table 2-2).
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