# Pupil Size and Diabetics - Why is it important?



## highvelocity84 (Dec 22, 2008)

Okay, so yes, I'm reviewing my final.

I don't know how looking at the pupils of a diabetic patient will give you important information 'bout the patient except that if they're PERRL, then there's no head trauma.

Appreciate any and all help!


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## TomB (Dec 22, 2008)

Equal pupils doesn't mean "no head trauma" but if it is present, it _may_ mean the patient is herniating. It's not a bad idea to check pupil size to establish a baseline on any patient with an abnormal neuro exam (and unconsciousness certainly qualifies). With an unconscious diabetic, you're suspecting insulin shock, but you don't know until you check the blood sugar, give D50, and the patient regains a normal level of consciousness.


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## daedalus (Dec 22, 2008)

Pupillary signs are much more complex then taught in EMT school and to some extent paramedic school. A "blown" pupil on one side may indicate stoke, while bilateral unreactivity may suggest other things. It would be nice for some of our more educated members to help us out with a tutorial of sorts. 

The unilateral blown pupil is caused by compression of cranial nerve II, which can be due to herniation or bleeding (and perhaps swelling with up ICP?).


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## Ridryder911 (Dec 22, 2008)

Actually checking PEARL (pupils equal and reactive to light) is hardly taught anymore to even physicians because of the poor correlation to neuro. Anisocoria which is those have unequal pupils (20% of the general population have this condition). There are more definite neurological evaluations that is faster to identify than the late differential of unequal or sluggish response to light. 

In regards to diabetes, diabetics are known to have poor neuropathy as in retinal artery destruction, glaucoma, cataracts also. Detailed examination such as checking the sclera for discoloration of jaundice such as in icterus can also be detected while looking at the pupils. In depth examination, (which the basic cannot examine) looking for poor retinal blood flow, retinal hemorrhage, and poor vision acuity. 

R/r 911


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## rhan101277 (Dec 22, 2008)

A fun fact is that the left eye's vision is interpreted by the right side of the brain, and the right eye's vision is interpreted by the left side.  The nerves criss-cross at the optic chiasma.

If I am wrong let me know.


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## el Murpharino (Dec 24, 2008)

Those with hypoglycemia will exhibit dilated pupils due to the catecholamine release...


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## Markhk (Dec 24, 2008)

We had a lady who presented with pin-point pupils after a head injury...and we were like what?! She was totally altered and combative. I talked to one of the stroke nurses and she mentioned that a lesion at the pons level can cause pinpoint pupils, and apparently the CT did show blood there...so not all pin-point pupils means opiate overdoses either. I did look it up in google after and the stroke nurse was right...  

They most certainly did NOT teach me that in medic skool! Ahhh I love how little I know...


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