I work in a LTC facility and have noticed on several residents during my initial assessment and neuro check that one of the pupils is either irregular in shape and or abnormal pupil response. According to the H&P this is a new onset, I put them on the MD list after calling the MD and being told to do so. The next time I work I see that the MD has found no problems and documents everything as normal ( including perrla) as well as the nurse continuing to document perrla. Low and behold the resident still has an oblong pupil or fixed? I have even had my findings double checked by an RN and she agreed with my assessment but the MD doesn't? I spoke with one of the nurses and she said " Oh that's how so and so always is, so i put perrla because its nothing out of the ordinary." Is this normal for the elderly? I have done dozens of google searches and only found congenital or trauma related problems correlating with abnormal pupil shape or response.I try very hard to do thorough assessments and I confused as to why I am the only one finding these anomalies? I can understand other nurses maybe not bothering to check but the MD? I feel like a fool for even mentioning it but I know I am not wrong, so why the brush off? I am not above error but when three nurses agree, why not the MD? anyone else experience this? Any advice would be welcome.