Relative Afferent Pupillary Defect in Compressive Optic Neuropathy Due to Meningioma

𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 35-year-old woman with a compressive optic neuropathy OS due to a meningioma. She had normal acuity and color OD, with 20/40 acuity and dyschromatopsia OS. There was loss of visual field OS with a mainly temporal defect, and optic nerve pallor was apparent in this eye as well. The video shows the swinging flashlight test, where a left relative afferent pupillary defect (rAPD) is apparent - e.g., when the light is shone in the right eye there is pupillary constriction, but when the light is moved to the left eye, there is pupillary dilation. It's as if the patient is in a bright room OD (i.e., the pupil needs to constrict), but then when moving the light from the right to the left eye, it's as if the patient is moving into a darker room (i.e., the pupil needs to dilate). The light should be held for the same duration on each eye - if the light is held on one eye longer than the fellow eye, this may cause a false positive in a normal patient. Loss of acuity, field and color vision with optic nerve pallor and an rAPD is highly suggestive of an optic neuropathy, which turned out to be compressive in this case. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: This video depicts the common features of an optic neuropathy, including relative afferent pupillary defect (rAPD), with ipsilateral pallor and loss of visual feld due to a compressive meningioma. https://collections.lib.utah.edu/ark:/87278/ s6m95jb6