Moisture and mydriasis

Why you may need a neurologist to see a comatose patient in the ICU

“…We care less about very wide or pinpoint pupils. Extremely wide pupils often respond and are medication induced [ 9 ]. Pinpoint pupils often do not respond, artifactually, and are also commonly opioid related.…”

The neurologic consultation: pointers and takeaways for intensivists

“…Misplaced concerns about right-and left-sided differences increase unnecessary bedside calls. Anisoria is often irrelevant; nebulized drugs repeatedly cause widening pupils [9]. Often the only cranial nerves examined by non-specialists, pupils are insignificant outside five classic conditions with major implications: large and small pupil (acute basilar artery occlusion); unilateral wide, fixed pupil (acute brain shift); middle-position, fixed pupils (major upper-brainstem injury); or intoxication pupils, which widen with cocaine and constrict with heroin.…”