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Background/Purpose

Pupillary assessment is an important part of neurological assessment because changes in the size, equality and reactivity of the pupils can provide vital diagnostic information in the critically ill patient (Smith, 2003).

Both pupils should be the same shape, size and react equally to light. Although not part of the Glasgow Coma Scale (covered in part three of this series next week), examination of the pupils is an essential adjunct to it, especially when the patient’s level of consciousness is impaired (Bersten et al, 2003).

Procedure

Carefully assess the size of the pupil in both light and dark conditions.
Check the reactivity of each pupil with a penlight or Finoff transilluminator.
Use the swinging flashlight test to look for a relative afferent pupillary defect.
Performed: Bilaterally

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Criteria

• Symmetrical size (<1 mm difference)
• Reaction to light changes

Measurement

LOINC Code

Scale/Grading