Medical emergencies in dentistry: assessing pupils

The Resuscitation Council (UK) (2011) recommends the ‘ABCDE’ approach (Box 1) to assess the acutely ill patient. A key component of ‘D’ is assessment of pupils because changes in their size, equality and reactivity can provide important diagnostic information in the critically ill patient (Jevon, 2014). Dental nurses must, therefore, understand how to assess the patient's pupils.

The aim of this article is to understand the assessment of pupils.

The pupil is the ‘black hole’ in the centre of the iris (a flattened muscular diaphragm which is attached to the ciliary body) (Figure 1); relaxation and contraction of the muscles of the iris cause the pupil to dilate (in darkness) or constrict (in bright light) (Marcovitch, 2005). Both pupils should be the same shape, size and react equally to light (Jevon, 2014). Any changes in the size or shape of the pupils and/or their reaction to light may indicate a serious problem in the brain.