Abstract
BackgroundPupillary evaluation is a crucial element of physical exams. Noting size, reactivity, and consensual response is critical in assessing for optic nerve dysfunction. We aim to establish normative data for scotopic pupillary size and function in the pediatric population in a clinical setting.MethodsPupillometry was obtained prospectively for consecutive, normal patients < 18 years old being evaluated by Lurie Children’s Ophthalmology. Quantitative data included maximum (MAX) and minimum (MIN) diameters, constriction percentage (CON), latency (LAT), average (ACV) and maximum (MCV) constriction velocities, average dilation velocity (ADV), and 75% recovery time (T75). Iris color was noted as light, intermediate, or dark.Results196 eyes of 101 participants (42.6% male, ages 1–17 years, average age 10.3 years) were analyzed. Mean MAX was 6.6 mm (5.1–8.1 mm 95% CI); MIN was 4.7 mm (3.1–6.1 mm 95% CI); CON was 30% (17–42 95% CI); LAT was 230 milliseconds (160–300 ms 95% CI); ACV was 3.70 mm/sec (2.21–5.18 mm/sec 95% CI); and ADV was 0.88 mm/sec (0.38–1.38 mm/sec 95% CI). Age had a positive correlation with MAX, MIN, and CON. 84.2 and 95.8% of participants showed resting pupil asymmetry of ≤0.5 mm and ≤ 1.0 mm, respectively.ConclusionsQuantitative pupillometry can be a useful tool for screening pediatric patients. We sought to establish normative data in this group. We found males to have significantly greater MCV and CON than females (p < 0.05). Also, age had a positive correlation with MAX, MIN, and CON.
Highlights
Pupillary evaluation is a crucial element of physical exams
Observation of pupillary size, reactivity, and consensual response is critical in the assessment of optic nerve dysfunction
Couret et al showed that trained nurses in Neuro Critical Care Units did not detect 50% of anisocoria and concluded that automated quantitative pupillometry is a more reliable method with which to collect pupillary measurements at the bedside [10]
Summary
Pupillary evaluation is a crucial element of physical exams. Noting size, reactivity, and consensual response is critical in assessing for optic nerve dysfunction. We aim to establish normative data for scotopic pupillary size and function in the pediatric population in a clinical setting. Observation of pupillary size, reactivity, and consensual response is critical in the assessment of optic nerve dysfunction. Several studies have described normative values [4, 5, 11] for pupillary function in a pediatric population as measured in ambient light conditions. Kohnen et al published a normative study [12] with scotopic pupil size This suggests a need for normative values, measured in a clinical setting, in a pediatric population that can be used for evaluating patients when suspicious of disease, and as a more accurate and sensitive screening tool. The present study aims to establish a normative database for scotopic pupillary size and function in children as measured in a clinical setting
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