|LETTER TO THE EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 105-106
Simple and novel technique for pupillary light reflexes
VP Ravichandran, PR Aswin
Free Section, Aravind Eye Hospital, Madurai, Tamil Nadu, India
|Date of Submission||18-Feb-2020|
|Date of Acceptance||20-Feb-2020|
|Date of Web Publication||17-Apr-2020|
Dr. P R Aswin
Free Section, Aravind Eye Hospital, Madurai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ravichandran V P, Aswin P R. Simple and novel technique for pupillary light reflexes. Kerala J Ophthalmol 2020;32:105-6
At the outset, we would like to congratulate the Dr Rita Mary Tomy for the article titled Pupil: Assessment and diagnosis. It was well written and managed to cover most of the important aspects of pupil examination and disorders of the pupil. We would like to provide an addition to the technique mentioned in the article on how to perform the direct and indirect light reflex test. With increasing use of slit-lamps, examination using torchlight and direct ophthalmoscope is becoming a lost art and yet extremely important in outreach camps where the ambient lighting may not always be ideal for pupillary examination. We believe the following technique to be a solution for this particular problem.
| Examination of Pupillary Action|| |
The examination of pupil should be ideally performed in a dimly illuminated room.
- Torch with 3–5 mm projection in its head end [Figure 1]
- Direct ophthalmoscope.
| Procedure|| |
Both the patient and the doctor should be seated at the same level comfortably.
| Examination of Direct Reflex for the Left Eye|| |
Close the patient's right eye with your left-hand thenar eminence touching the lateral wall of the nose. Hold the torch in your right hand and throw its light obliquely (about 60° angle) on the left eye and examine the pupillary action carefully [Figure 2].
|Figure 2: Correct technique of occlusion of the right eye using the left thenar eminence and torch being held in the right hand|
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Then, document the findings.
Closing the eye with your thumb or fingers is not advised as the torchlight can enter the eye [Figure 3] and [Figure 4].
Switch hands to examine the right eye using the same technique.
| Examination of Indirect Reflex for the Left Eye|| |
Hold the torch obliquely in your left hand over the right eye, touching the nose and hold the direct ophthalmoscope in your right hand, as shown in [Figure 5] and [Figure 6].
|Figure 5: Checking the indirect light reflex using Direct ophthalmoscope which provides the dim illumination to observe the left pupil while the torch provides the bright illumination for the right eye|
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|Figure 6: Close up view showing how the Direct ophthalmoscope dimly illuminates the left pupil allowing for easy detection of the consensual reflex when stimulating the right eye|
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Throw the ophthalmoscope's dim light through its largest aperture on the left eye obliquely so that the pupil can be seen dimly. Switch on the torch (to stimulate the right eye) and observe the changes in the left pupil. Note down the findings.
In the same way, right eye pupil can be examined and the findings to be noted down.
| Conclusion|| |
We have observed that this particular technique to be simple, effective and it can be done even in the eye camps where despite the varied ambient lighting, the only requirements are a torch and direct ophthalmoscope. The ease of performing and training others is also a reason why we would like to recommend this technique for all postgraduates.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Tomy RM. Pupil: Assessment and diagnosis. Kerala J Ophthalmol 2019;31:167-71. [Full text]
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]