Pupilla learning lab
Eye Exam Simulator
A virtual patient with 43 conditions: penlight pupil exam and RAPD, cover tests, Hirschberg and Krimsky, ductions and versions, cranial nerve palsies, INO, gaze palsies and nystagmus.
- Free in your browser
- English & Arabic
- Education & training
Your first practice session
- Start with a normal examination and establish a baseline.
- Select a condition, then examine pupils, alignment and gaze systematically.
- Explain the finding before comparing it with the guide.
Common mistakes to avoid
- Naming a condition before observing the signs.
- Confusing an afferent pupil defect with an unequal pupil size.
For education and training only. Pupilla is not a medical device and must not be used for diagnosis or treatment decisions.
Understand the principles
RAPD and the swinging flashlight test
A relative afferent pupillary defect (RAPD), or Marcus Gunn pupil, means one eye sends a weaker light signal to the brainstem than the other. It is found with the swinging flashlight test: when the light swings from the healthy eye to the affected eye, both pupils dilate instead of staying small. An RAPD points to asymmetric optic nerve disease or extensive retinal damage, and on its own it does not make the pupils unequal in size.
The cover test: cover–uncover, alternate cover and prism cover test
The cover test detects and measures strabismus. In the cover–uncover test you cover one eye and watch the other: if the uncovered eye moves to take up fixation, there is a manifest deviation (a tropia). If no tropia is seen but the covered eye moves back into line when the cover is removed, there is a latent deviation (a phoria). The alternate cover test breaks fusion to reveal the total deviation, and adding prisms until the movement stops (the prism cover test) measures it in prism dioptres.
Ocular motility and the H-test: ductions, versions and the nine positions of gaze
The H-test examines eye movements by asking the patient to follow a target in an H shape through the six cardinal positions of gaze. In each of those positions one muscle of each eye is the main mover, so an eye that lags in a position points to weakness of the muscle that works best there. Versions are movements of both eyes together, ductions are movements of one eye with the other covered, and vergences move the eyes in opposite directions. Adding straight up, straight down and primary position gives the nine positions of gaze, which also reveal A and V patterns.
Try a virtual patient
Teaching examples in the exam simulator. Observe and explain the signs before comparing cases.
Questions about this simulator
What can I practise with the Eye Exam Simulator?
A virtual patient with 43 conditions: penlight pupil exam and RAPD, cover tests, Hirschberg and Krimsky, ductions and versions, cranial nerve palsies, INO, gaze palsies and nystagmus.
Do I need to install software or create an account?
Open the simulator free in a modern browser without installation. An account enables supported saved progress and results; coverage varies by module.
Can I use a phone or tablet?
You can access it in modern phone and tablet browsers. A larger screen gives diagrams and controls more space; performance depends on the device and browser.
Does this replace clinical training or patient diagnosis?
For education and training only. Pupilla is not a medical device and must not be used for diagnosis or treatment decisions.
References & further learning
Sources for the teaching principles. Listing a source does not imply its institution endorses or validates this simulator.