Pupils In Comatose Patients

Front 1

Guess What ?

Back 1

Pupillary size, equality, and light reactions help in assessing the cause of coma ind in determining the region of the brain that is impaired. Remember the unrelated pupillary abnormalities, including miotic drops for glaucoma or mydriatic drops for a better veiw of ocular fundi, may have preceded the coma.

Front 2

Caused by damage to sympathetic pathways in the hypothalamus or metabolic encephalopathy / Light reactions are usually normal

Back 2

Bilaterally Small Pupils (1 - 2.5 mm)

Front 3

Caused by hemorrhage in the pons or the effects of morphine, heroin, and other narcotics / Light reactions may be seen with a magnifying glass

Back 3

Pinpoint Pupils (< 1 mm)

Front 4

Pupils that are midposition or slightly dilated (4 - 6 mm) / Fixed to light suggest structural damage in the midbrain

Back 4

Midposition Fixed Pupils

Front 5

Due to severe anoxia and its sympathomimetic effects as seen after cardiac arrest / May result from atropinelike agents, phenothiazines, or tricyclic antidepressants

Back 5

Bilaterally Fixed and Dilated Pupils

Front 6

Due to cocaine, amphetamine, LSD, or other sympathetic nervous system agonists

Back 6

Bilaterally Large Reactive Pupils

Front 7

Warns of herniation of the temporal lobe causing compression of the oculomotor nerve and midbrain

Back 7

Unilateral Fixed and Dilated Pupil