Other gross observations for abnormalities could include evidence of corectopia (displaced pupil), polycoria (multiple pupils), leukocoria (white pupil, which can be an ominous sign of a serious ocular form of cancer known as retinoblastoma), or iris heterochromia (difference in iris colors between the two eyes).Īlthough pupil testing provides gross observations in these areas, the slit lamp can be used to examine the pupil and iris in more detail. Non-round pupillary shape can occur as a result of a surgical complication, posterior synechia from intraocular inflammation, or iris atrophy from age, ischemia, inflammation, or trauma. The red reflex provided when viewing through the direct ophthalmoscope can be helpful when comparing the two eyes. Observing pupil shape, location, and sizeĪ normal patient’s pupils should be round, symmetrical, and centered within the iris. The equipment required to perform pupil testing is minimal: all you need is a millimeter ruler or pupillary gauge and a transilluminator (which is preferred over a disposable penlight due to the intensity of the light). If the patient is unable to see the 20/400 E, the red/green filter can be utilized over the optotype, and the patient should be instructed to fixate on the colors.Ī target that is too small for the patient might result in accommodation, with associated with pupillary constriction, which you will want to avoid when testing pupils. This article will focus on the proper procedure for testing pupils as well as point out some of the more commonly encountered pupil abnormalities.īefore testing pupils, the patient should be instructed to remove her spectacle correction.Ī distant, non-accommodative target two to three lines larger than the patient’s uncorrected visual acuity should be utilized. This procedure should be included as a component of every comprehensive examination or any time a patient needs to be dilated-in addition to any problem-focused visit involving eye health, such as a red eye visit, ocular emergency, or intraocular pressure (IOP) check. Because of its potential to reveal serious retinal, neurologic or other disease, pupil testing is a crucial part of the ophthalmic examination and requires astute observation.
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