pupillary reactions. They’ll move it toward you, away from you, and from side to side. The eye assessment includes: Inspection of the eyes for abnormalities, Testing the cranial nerves responsible for eye function: III, IV, VI, Assessing for nystagmus, accommodation, pupil size and reactive to light etc. not. Evaluation of pupillary reaction is effectively an assessment of the third cranial nerve (oculomotor nerve), which controls constriction of the pupil. Compression of The diagnosis can be easily made on slit-lamp examination: an acute episode will show ciliary injection, endothelial dusting, aqueous cells, anterior vitreous cells and in severe cases hypopyon and posterior synechiae. It is a relatively simple examination that can be performed at most patients’ bedsides and is a skill all doctors should have. By Li Yen Goh Normal pupil reflexes. If the light is shone, the pupil constrict. For the purpose of neurological assessment the size and reaction of the pupils to bright light are recorded. Normally, pupils are equal in size and about 2 to 6 mm in diameter, but they may be as large as 9 mm. To start at the beginning, the pupil is the central aperture of the iris, its size controlling the amount of light falling on the retina, varying in diameter from about 1-8mm. On slit-lamp examination, pigment deposits on the lens, keratoprecipitates can be seen and in some cases iris nodules and atrophy will also be present. Eyes Opening and Pupillary Reaction. They should shrink when watching an object that’s shifting perspectives. The pupillary light reflex is a test of the functional integrity of the subcortical afferent and efferent pathways and is reliably present after 31 weeks, gestation. Get the patient to fix their eyes on a distant point to begin with, then to observe the pupils through a side illumination. If the pupil reacts briskly to light: record as '+' b. All rights reserved. Physiological anisocoria occurs in about 25% of individuals but the difference in size should not be more than 1mm. The pupillary light reflex or photopupillary reflex is a reflex that controls the diameter of the pupil, in response to the intensity of light that falls on the retinal ganglion cells of the retina in the back of the eye, thereby assisting in adaptation of vision to various levels of lightness/darkness. Normal pupils have a centralized location, equal size, and round. The use of eyedrops should always be considered when presented with bilateral constricted or dilated pupils. Finally, accommodation can be tested by asking the patient to fixate on a distant point and then asking them to shift their focus quickly to a near object. Check the face for impaired sweating on the same side (may be easier to ascertain this information from the history). 5.3 Assessment. Figure 3: A patient with left sided Adie’s pupil. I guarantee you will never see a case of this in your entire career, but you will be punished by examiners for not knowing it. direct pupillary response. How to check the pupil reflexes response for direct and consensual responses and accommodation using a pen light. Some supplements may improve eye health, though more research is needed. Morales J, Brown SM, Abdul-Rahim AS, Crosson CE. Ocular effects of apraclonidine in Horner syndrome. A third nerve palsy can either be complete or partial. PUPILLARY ASSESSMENT. Gravity. Note pupil size and shape in ambient lighting. Step 2 – Direct and consensual light reflexes. A post-cocaine anisocoria of greater than 0.8mm confirms a Horner’s pupil on the side of the smaller pupil. When light is shone on the normal side, the pupil constricts but when the light is quickly shifted to the abnormal side, that pupil will dilate. This assessment is part of the nursing head-to-toe- assessment you have to perform in nursing school and on the job.