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Pupil abnormalities may be physiological, pathological or pharmacological. It can indicate the underlying disease of the visual afferent system or visual efferent system. Examination of the pupils is therefore a part of eye examination. Insufficient knowledge and inconsistent methods in the pupillary examination by some ophthalmologists lead to mistakes or unreliable results, hampering the disease diagnosis and clinical assessment. This article emphasizes the significance of pupillary examination outcomes, advocates for standardized examination methods, and highlights the need to enhance the awareness of pupillary abnormalities, aiming to provide a guide on how to recognize and interpret the clinical implications of pupillary abnormalities, and to offer valuable insights for clinical practice.