Ultrasound pupillary assessment in the critical patient

Excerpt

A 32-year-old patient underwent an operation for a subdural hematoma related to a severe motorcycle crash. After the intervention, she presented with voluminous facial edema. Her eyes could not be opened, and pupillary assessment seemed impossible. Therefore, we used an ultrasound (Micromax, Sonosite^®, linear probe) with a lateral tangential approach. The pupillary diameter was measured and the photomotor reflex assessed by trans-palpebral lighting. The right pupillary diameter was 4.3 mm and was not modified by lighting. The left pupillary diameter was 2.4 mm and 1.4 under lighting (Fig. 1; the video shows the photomotor reflex). This fast, easy to perform and very precise exam allowed complete neurological assessment of the patient. It contributed to optimizing the patient’s management. Therefore, it should be widely used in trauma patients, particularly in cases of dim light, dark eyes or facial edema. Furthermore, edema dramatically facilitated the eye exam as it improved the probe’s contact.

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