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Modified pupil examination technique prevents corneal light reflex
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NEW YORK — The traditional means of examining pupils, which involves patients staring straight ahead and having light shined along the visual axis, often results in a corneal light reflex, making it difficult to see the iris and pupillary reaction, according to a presenter here.
A study published in the Journal of Neuro-Ophthalmology suggested that surgeons instead shine light on the inferior limbus while patients stare upward, Michael S. Lee, MD, told colleagues at OSN New York 2011.
"What are the advantages of this technique? Well, predominantly, it's [avoiding] that corneal light reflex," Dr. Lee said. "But for those blinky individuals, now the patient is looking upward, and they are firing both their superior rectus as well as their levator palpebrae, and they are not going to blink as much."
For patients with presbyopia, there is some mild magnification that occurs through the peripheral cornea that would not otherwise occur through the central cornea, Dr. Lee noted.
Addressing other issues in neuro-ophthalmology, Dr. Lee recommended that when identifying an aneurysm in patients with third nerve palsy, the imaging order form should specify third nerve palsy and go directly to a neuroradiologist. He also recommended 0.5% apraclonidine to dilate a Horner's syndrome pupil and Visine (tetrahydrozoline ophthalmic solution, Johnson & Johnson) to elevate the eyelid, but cautioned that apraclonidine should not be used in children due to potentially life-threatening adverse events.
- Disclosure: Dr. Lee has no relevant financial disclosures.