01/27/2026
Pupils are the window to the brain🧠
And if you don't know what you're looking for, you could miss a LIFE-THREATENING emergency.
PERRLA isn't just a checkbox on your assessment form - it's your early warning system for:
⚠️ Increased ICP
⚠️ Stroke
⚠️ Herniation
⚠️ Drug toxicity
⚠️ CN III damage
Let me break down what separates "checking the box" from actually ASSESSING:
✅ NORMAL = PERRLA
Both pupils 2-6mm, equal size, brisk constriction to light, smooth symmetric response
🚨 EMERGENCY SIGNS:
• Blown pupil (fixed, dilated >6mm, non-reactive)
• Pinpoint pupils 1mm difference (anisocoria)
If you see these? NOTIFY MD IMMEDIATELY.
This shows up in:
→ Neuro checks q15min-q4hr
→ Post-op assessments
→ Trauma patients
→ NCLEX priority questions
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