1. Observe:

•         anisocoria
•         heterochromia
•         ptosis

3. Reaction to direct and consensual light

4. Swinging light test for afferent pupillary defects

5. Reaction to accommodation

6. Additional examination depends on the above findings
 

• RAPD (look at the disc for pallor or cupping or total retinal detachment)
• Horner's syndrome (neck or chest scar)
• Third nerve (ocular motility)
• Adie's pupil (slit-lamp for vermiform iris movement and knee jerk)
• Argyll-Robertson's pupil(interstitial keratitis, deafness)

In the absence of anisocoria, the most likely case is relative afferent pupillary defect and less commonly you get light/near dissociation.
In the presence of anisocoria, you are likely to be asked about differential diagnosis and the pharmacological diagnosis of anisocoria. Always have a list of causes for abnormal small or large pupil and learn the pharmacological diagnosis for Horner's syndrome and Adie's pupil well

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