Unilateral afferent pupillary defects in asymmetric glaucoma.

Unilateral relative afferent pupillary defects are associated with unilateral prechiasmal lesions affecting the retinomesencephalic pathway. Five patients with unilateral or asymmetric glaucoma and relative afferent pupillary defects are presented. The lack of descriptions of relative afferent pupillary defects in unilateral glaucoma may be explained by the frequency with which these patients are treated with miotics, the association of trauma, and the presence of anatomic alterations of the iris. It is important to distinguish unilateral afferent pupillary defects in glaucoma from those associated with other neuro-ophthalmic disorders that require more invasive diagnostic procedures.