The pupillary exam first checks for light and then accommodation. So, we are going to turn on our penlight, have the patient look in the distance still.
-“Look in the distance.”
When you are checking the pupils, come from the side. If I come from in front of him, he’s going to accommodate on the light and actually the pupil will constrict because of accommodation. We don’t want that to happen. We want his eyes to constrict only to the light.
-“Look over there, sir.”
And come from the side. The direct response, and you can see there was also a consensual response in the other eye. Now do the direct response, and you can see the other eye also in the consensual response.