Technological advancements have made the automated pupillometer a significant tool in the critical care of severe TBI patients
Pupils During the initial inspection, it's crucial to keep a close eye on the pupil size and responsiveness to light. The parasympathetic axons are impaired by compression of the oculomotor nerve, which can indicate temporal lobe/uncal herniation and result in modest pupillary dilation and a sluggish pupillary light response. Bilateral miotic pupils (1–3 mm) can also arise in the early stages of herniation due to a breakdown of the hypothalamic pupillomotor sympathetic pathways, allowing parasympathetic tone and pupillary constriction to predominate. The pupil dilates and the light response becomes paralysed as the herniation progresses. Ptosis and paresis of the medial rectus and other ocular muscles innervated by the oculomotor nerve manifest with full mydriasis (8 to 9 mm pupil). To determine pupillary light responses, a bright light in a darkened area is always required. Clinical trials of computerised pupillometry were conducted in the past, with initially mixed ...