Vision Screening Online Training Program - Pupillary Light Response

Vision Screening Online Training Program

Module 5 (continued): Pupillary Light Response
(C&TC: Often performed by the health care provider)

The pupillary light response is used for making sure a child’s eyes respond appropriately to light. A failure of a pupil(s) to constrict or dilate quickly and/or equally may be in response to lesions on the retina, ocular nerve damage, or even blindness and requires a referral to a health care provider.

Ages: Birth to age 3 years or when visual acuity can be measured.

To check for the pupils' reaction to light changes.

Description: Observing the child's pupil for symmetrical reaction to light.
Equipment: Penlight or other light source.
Facilities: Normal or lower light level.

First observe the child's eyes noting if the pupils are of equal size. Approaching from the side, at eye level, shine the light into the right eye - the pupil should quickly constrict. Observe the left eye to see if it has equally constricted (consensual response). Remove the light - both eyes should dilate. Repeat the procedure on the left eye.


Image of screener shining a penlight into the eyes of a child.

Make sure that the penlight is directly in line with the child’s eyes. Even though the light is shined into only one eye at a time, make sure that both eyes react to this stimulus.

Pass: Pupils quickly constrict when light is introduced and almost as quickly dilate when light is removed. The pupils remain equal in size.
Re-screen/Refer: Sluggish or no response upon the introduction or removal of the light; or if the pupils become unequal in size.
NOTE: The screener may observe the pupils dilate and constrict several times after illumination. This is a normal occurrence called Hippus.


While performing the pupillary light response, as long as both pupils constrict in response to the light, it does not matter if one pupil is slower than the other pupil.

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