Abnormal pupil shapes may be described as ovoid, keyhole or irregular. The shape of each pupil should be recorded. Unusual eye movements (such as nystagmus) must be reported You may need to hold the patient’s eyes open (Fig 6) If the pupil is sluggish in response when compared with the other pupil it is documented as ‘S’ If the pupil does not react to light it is documented as ‘-’ If the pupil reacts briskly to light it is documented as ‘+’ In normal eyes, both pupils contract when light is shone into either eye (Fig 5) A bright light is shone into each eye (moving from the outer corner of each eye towards the pupil) (Figs 3-4) An ovoid pupil may be an indication of intracranial hypertension The shape of the pupil should also be assessed. A millimetre scale is used to record the size of each pupil (Fig 2) The pupils should first be observed simultaneously to determine size and equality. Reduce any external bright light so that pupil reaction can be monitored and position the patient so that you can see their eyes (Fig 1) The procedureįor the purpose of neurological assessment: Pupils are normally round and equal in size (2-5mm). Pupillary changes may be a sign of pressure on oculomotor or optic nerves and increased intracranial pressure. Within neurosurgical intensive care and high dependency units, a GCS assessment of the patient must be done at verbal handover or the beginning of the shift by both nurses (together) in order to avoid misinterpretation and facilitate continuity.Ĭonsent should be obtained from the conscious patient and each step should be explained as required. Dilation is a very safe procedure and with the right preparation you should experience little inconvenience and discomfort.- One dilated or fixed pupil may indicate an expanding/developing intracranial lesion, compressing the oculomotor nerve on the same side of the brain as the affected pupil. You may not be able to do any close work that requires eye coordination (such as reading or sewing) for a few hours after the exam. Most people experience few side effects other than blurry vision and a sensitivity to light for a few hours after the exam. Dilation is also important for people taking medication such as Hydroxychloroquine (Plaquenil tm) and prednisone. People with diabetes should have their eyes dilated at least once a year so that their doctors can monitor the effects of the disease on their retinas. The procedure allows your eye doctor to examine your eyes for problems such as retinal detachments, glaucoma and macular degeneration. Doctors use dilated exams to screen for any problems that might threaten your vision. You don't need to have something wrong with your eyes to require a dilated exam. If there are any signs of problems or disease, there is a better chance of detecting them by viewing the entire internal eye. When the pupils are dilated, it's like opening the door of the closet, allowing the doctor to see a larger area including the outer edges of the eye. Looking through a normal pupil is like looking through a keyhole into a closet. With the pupils dilated, your doctor has a better view of the lens (the clear part of the eye behind the pupil that light travels through) and the retina (the back lining of the eye that contains the optic nerve and the only visible blood vessels in the body). These drops cause your pupils (the black areas in the center of the eyes) to open wider (dilate). A dilated examination allows your eye doctor to see the entire inside of your eye by using eyedrops.
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