TBI: Pupillary Evaluation and the Application of Pupilometry
Pupillary evaluation and pupilometry are highly accurate methods for evaluating the functional status of the brain.
This article will discuss how doctors can use pupilometry as an objective indicator of acute brain injury following head trauma, including concussion, subarachnoid hemorrhage, and intracerebral hemorrhage (ICH).
The Importance of Pupillary Evaluation in Traumatic Brain Injury Patients
Pupillometry is a vital tool for assessing traumatic brain injury (TBI).
Health professionals can use it as an initial screening tool to monitor pupil size changes over time. This can help identify patients at risk for developing secondary brain injury because of inadequate blood pressure or cardiovascular instability. Pupilometry is also used to monitor the effectiveness of treatment and surgical repair of ruptured intracranial aneurysms.
Pupillary evaluation is a reliable method for assessing TBI severity and prognosis, especially where imaging studies may be unavailable or inconclusive.
What are the dangers of manual pupillary assessment of TBI patients?
Manual pupillary assessment is unreliable.
The human eye can fool someone into thinking it is dilated when it really isn’t, or, conversely, appear constricted when it should be dilated. This presents a serious difficulty to the accurate diagnosis of TBI patients because it renders any manual pupillary assessment results inaccurate and time-consuming.
Manual pupillary assessment is subjective, not objective.
When using a device such as a pupilometer to evaluate the pupils of an injured patient, there’s no room for subjectivity—the equipment uses computerized algorithms programmed to tell the doctor how dilated or constricted their patient’s pupils are based on pupil measurements.
Manual pupillary assessment can be time-consuming and non-reproducible from one examiner to another.
This is because all examiners might have different opinions about what makes up normal pupil size and reactivity when assessing TBI patients with mild injuries versus severe ones. This again makes manual measurement unreliable for diagnosing head injuries during trauma care assessments.
Pupilometry as a Tool to Measure Post-Traumatic Brain Injury Response
A pupillary light reflex test is a non-invasive technique to measure the response of a patient’s pupils to light stimulation.
When a doctor exposes the patient’s eyes to bright lights, there is an increased constriction of the pupils. Doctors can use pupilometry to measure and quantify this process. They can use pupillometry as a tool for measuring the post-traumatic brain injury response in:
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Neurocritical care
A pupil is a powerful tool for assessing brain function.
It can be use to evaluate and monitor patients with TBI, stroke, intracranial hemorrhage, and other neuropathologies. Pupillary evaluation provides an assessment of the integrity of the retinal pathway and useful information regarding brainstem function.
Pupillary evaluation is quick, non-invasive, easy to perform, and inexpensive compared with other tools, such as CT or MRI scans, which are commonly used in hospital settings.
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Surgical intensive care
The pupilometer is a useful tool in surgical intensive care.
It can measure the pupillary light reflex and estimate the extent of TBIs. This can be done by comparison with direct ophthalmoscopy, which may not be possible if the patient has undergone eye surgery or if there is damage to their eyes. In addition, direct ophthalmoscopy will cause increased light exposure for patients experiencing photophobia.
This is where the pupilometer comes in.
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Medical intensive care
Pupillary evaluation is a valuable tool in medical intensive care.
The pupil is the center of ocular reflexes, and when assessing a person with TBI, it can provide valuable information about their brain injury. It is also important to note that pupillary evaluation can help determine the effectiveness of treatment for TBI patients because the size and shape of their pupils may change over time as their neurological status changes.
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Trauma and emergency care
The pupilometer is a tool that health professionals can use in the emergency room.
It is a device that works by measuring the size of a patient’s pupils in response to light stimulation. The device comprises two separate cameras: one for each eye. When a patient looks at the center of the screen, which has a blue dot at its center. Their eyes will dilate so that their pupils expand away from each other (i.e., they will become rounder).
In this way, doctors can detect any injury or damage to either hemisphere of the patient’s brain; they can also determine whether there has been an increase or decrease in blood flow to certain areas after an accident or serious event, such as a traumatic brain injury (TBI).
Why should doctors employ the pupilometer in evaluating the pupillary light reflex?
The pupilometer is a useful tool for measuring the pupillary light reflex.
It has the ability to measure pupil size and pupil reactivity, which can lead to an early diagnosis of TBI. The robustness of the measurement allows doctors to use it while examining patients with traumatic brain injuries and other conditions. Pupilometry is also beneficial in monitoring recovery from brain injury because it enables patients with severe TBIs who cannot communicate effectively enough for traditional assessments like speech therapy or cognitive testing to use it.
