J Neurocrit Care.  2022 Dec;15(2):79-87. 10.18700/jnc.220085.

Quantitative assessments of pupillary light reflexes in neurocritically ill patients

• Kim TJ

• KMID: 2538764
• DOI: http://doi.org/10.18700/jnc.220085

Abstract

The pupillary light reflex (PLR) is a component of bedside neurological examinations in neurological intensive care units (neuroICUs). A quantitative pupillometer provides a non-invasive and objective pupil reactivity parameter clinically significant for changes in PLR in neuroICUs. This article reviews the physiology and importance of the PLR and the parameters of quantitative pupillometers. Moreover, this review discusses the clinical applications of quantitative pupillometers for post-cardiac arrest prognostication and monitoring of elevated intracranial pressure and neurological worsening in stroke, seizures, and other neurological diseases in the neuroICU. Quantitative pupillometry is a routine part of neurological examinations and an important monitoring tool for neurological diseases in neuroICUs.

Keyword

Abnormal pupillary function; Neurological examination; Assessment; Outcomes; Critical care

Figure

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  Fig. 1. Phases of the pupillary light reflex measured by a quantitative pupillometer. Latency is the time of onset of constriction following a light stimulus. The constriction velocity and maximum constriction velocity were calculated using the slope and maximal slope, respectively, during the constriction phase. During the dilation phase, dilation velocity was evaluated using the slope of the dilation phase. Max, maximum; Avg, average. Reprodued from Packiasabapathy et al. Can J Anaesth 2021;68:566-78 with permission of Springer Nature [16].

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  Fig. 2. Quantitative pupillometers devices and parameters. (A) Neuroptics NPiTM-200 and result screens. (B) NeuroLight-Algiscan and result screen. Reprodued from NeuroOptics (https://neuroptics.com/npi-200-pupillometer) and IDMED (https://www.idmed.fr/en/analgesia) with permission.

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