These results suggest that elevated ICP may be manifest in the PLR as decreased neurologic pupil index (NPi) and constriction velocity (CV), without significant change in pupil size. A recent study by McNett et al ( 4) explored associations between measures of PLR and intracranial pressure (ICP). Increased use of this technology has led to more research. The traditional pupillary assessment performed using a penlight is being gradually replaced with automated pupilometer assessments ( 1–3). Our findings confirm and extend those of McNett et al Worsening measures of the pupillary light reflex using automated pupillometry are associated with elevated intracranial pressure.Įxamination of the pupillary light reflex (PLR) is essential to a comprehensive neurologic assessment. In the setting of increased intracranial pressure, mean pupilometer values were lower for both left and right eyes comparing to normal intracranial pressure, except right neurologic pupil index (3.98, 3.92 p = 0.0300) and left latency (0.27, 0.25 p < 0.0001). Analysis of t-test indicates statistically significant differences for all right and left mean pupilometer values, except right latency ( p = 0.3000) and repeated measure mixed model ( p = 0.0001). To evaluate findings by the previous author, we explored for differences among measures of the pulmonary light reflex obtained from automated pupillometry with ICP values dichotomized as < 15 mm Hg (normal) versus ≥ 15 mm Hg (elevated). Within the Establishing Normative Data for Pupillometer Assessments in Neuroscience Intensive Care registry there were 273 patients (16,221 pupillary observations) that included both intracranial pressure and pupillometry values. In a diverse, multicenter population, to confirm or refute the conclusions that pupillary light reflex changes are associated with increased intracranial pressure. The work cannot be changed in any way or used commercially without permission from the journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. Supported, in part, by grants from NeurOptics.įor information regarding this article, E-mail: Al-Obaidi has disclosed that he does not have any potential conflicts of interest. Atem, Stutzman, and Olson received salary support from NeurOptics for the research study. Olson contributed in investigation, conceptualization, writing original draft, supervision, and funding acquisition.ĭrs. Stutzman contributed in resources, writing original draft, and project administration. Atem contributed in conceptualization, formal analysis, data curation, supervision, methodology, writing review, and editing. Al-Obaidi contributed in conceptualization, formal analysis, data curation, and writing original draft. This work was performed at the University of Texas Southwestern Medical Center, Dallas, TX. When your doctor examines your pupils, he or she will first look for anisocoria.1School of Medicine, University of Texas Southwestern, Dallas, TX.ĢDepartment of Biostatistics and Data Science, University of Texas at Houston, Houston, TX.ģDepartment of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX.ĤDepartment of Neurological Surgery, University of Texas Southwestern, Dallas, TX. In dark or dim light, the pupil dilates to allow more light into the eye to improve vision. In bright light, the pupil constricts to reduce the amount of light entering the eye. How does a doctor check your pupil reflexes? Note the size (mm) of each pupil if available use the scale printed on the neurological assessment chart as a comparison (Fig 4). Look into each of the patient’s eyes, examining the size of the pupils (Fig 3). How are pupils measured in a neurological assessment?Īdopt a position in front of the patient. Unfortunately this takes too much time, especially for images with many small and separate edges. The simplest way to separate the edge of a pupil from other edge regions is to do region labelling in the whole edge image, and the largest region is chosen to be the pupil’s edge. How do you measure the size of the pupil? A light will be shone into your eyes from each side. Your doctor will first dim the lights, then ask you to look at an object in the distance. The light response pupil test assesses the reflex that controls the size of the pupil in response to light. How does the light response pupil test work?
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