Pupil Assessment

Pupil assessment is a vital sign that can assist with diagnosing or guiding treatment decisions particularly for patients with any change in level of responsiveness, confusion, neurological symptoms, or head injury.

Terms used to describe the pupils

• The pupil should naturally get smaller (constrict) when exposed to light

• The pupil should naturally get larger (dilate) when removed from light

How to Assess

To assess pupillary response you will simply need some light. This can be done without a flashlight by covering the patients eyes to shield them from the ambient light in the room and then having them open their eyes while uncovering them. For more accurate and quicker result use a penlight by shining it from the side of their face closer to the eye and repeating on the opposite eye.

Normal Findings

Normal pupillary response is described using the acronym PERRL. This stands for Pupils are Equal (same size as each other) Round and Reactive (constrict when exposed to light) to Light.

 Abnormal Findings

Constricted and unresponsive:

• This could be a sign of an Opiod poisoning event 

Dilated and unresponsive/slow:

• This could be a sign of hallucinogen drug use

One Pupil Dilated and unresponsive/slow:

• This could be a sign of a head injury

Overall pupils are a helpful vital sign for assessment especially when compared to other vital signs assessed particularly Level of Responsiveness, Breathing, Pulse, Skin, and Blood Pressure.

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