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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Neurosci+Rural+Pract
2015 ; 6
(2
): 208-15
Nephropedia Template TP
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Pupil to limbus ratio: Introducing a simple objective measure using two-box
method for measuring early anisocoria and progress of pupillary change in the
ICU
#MMPMID25883482
Mojumder DK
; Patel S
; Nugent K
; Detoledo J
; Kim J
; Dar N
; Wilms H
J Neurosci Rural Pract
2015[Apr]; 6
(2
): 208-15
PMID25883482
show ga
INTRODUCTION: Measurement of static pupillary size in the ICU is of importance in
cases of acutely expanding intracranial mass lesions. The inaccuracies with
subjective assessment of pupillary size by medical personnel preclude its use in
emergent neurological situations. OBJECTIVE: To determine if the ratio of pupil
to limbus diameter (PLD ratio) measured by a two-box method is a reliable measure
of pupil size for detecting early anisocoria and measuring pupillary changes.
MATERIALS AND METHODS: The PLD ratio was defined as the ratio of the pupillary
diameter measured at a para-horizontal axial plane with the limbus diameter
measured at the same or parallel axial plane. A two-box method was used to
estimate the diameters of imaged pupils. Eyes were imaged using an iPhone 4S
cellphone camera. Background illumination was measured and kept constant. The
pupils of a 78-year-old woman, who presented with a large intra-axial parenchymal
hemorrhage, were imaged. The patient had left pupillary miosis in dark but not in
bright light. After presenting this case along with the images of the pupillary
examination, a group of 21 medical staff were asked several questions on the
pupillary examination. Reliability of PLD ratio were assessed via standard error
of mean (S.E.M) of PLD ratios for 3 different subjects each imaged under constant
illumination and fixation but from different angles to the optical axis. RESULTS:
Analysis of questionnaire data together with PLD ratios revealed that ~ 14% and
10% of participants could estimate the pupillary size in darkness and bright
light respectively but none were simultaneously accurate indicating that
subjective assessment of pupillary size was unreliable. The approach towards a
systematic pupillary examination was inconsistent among the participants. The PLD
ratio was found to be a reliable measure of pupillary size with standard error of
mean below 0.1 mm for the three subjects tested. CONCLUSION: Static pupillary
sizes can be objectively and consistently evaluated using PLD ratios using a
two-box method. PLD ratios are resistant, within limits, to changes in imaging
angle or choice of para-horizontal axes for measurement.