PERRLA is Not Adequate

.Summary: • PERRLA is an abbreviation that is going to appear in many charts o But it has no assessment of the three pieces that we need o We must check in the light and in the dark • Why PERRLA is not enough o We're not testing their accommodation when we're testing their pupil o We're testing their response to light and near o When we're looking at pupils, we need to test both in the light and in the dark o We have to swing the flashlight for a Relative afferent pupillary defect • Normal Pupil o If we shine the light into the right pupil, both pupils will constrict o But also, that will be felt by the contralateral pupil because the innervation to the nucleus is bilateral o Both pupils are dilating because they're connected and so both pupils will dilate • What should we do? o When we have a RAPD on the left eye, we need to do the swinging flashlight test o Likewise, if we have a poorly reactive pupil to light, we need to check both the near reaction and the light reaction o We need to test all three pathways: the sympathetic and the parasympathetic pathway, light and dark, and we need to record the pupil size in the light and the dark o We need to swing the flashlight from the right to the left and from the left to the right to detect if there's a defect in the pupil pathway