PERLA

[tbell2]

Pupils equal and reactive to light and accommodation.

I just don't know what the accommodation part means... Any help?

[BluegrassRN]

http://en.wikipedia.org/wiki/Accommodation_(eye)

Incidentally, at my facility we document PERRL: pupils equal, round, reactive to light. Honestly, we nurses don't check for accommodation frequently.

[CoffeemateCNA]

Pupils equal and reactive to light and accommodation.

I just don't know what the accommodation part means... Any help?

This is accommodation (in a nutshell):

When you focus on an object that is far away, your pupils will slightly dilate. If you focus on something like a finger or a pen, and bring it closer to your eye, your eyes will converge and the pupils will constrict.

Sluggish accommodation can be a drug effect, and lack of accommodation can signal a cranial nerve problem.

[Metody]

If it helps any, accomodation looks kind of like the eyes are slightly crossing and the pupils are getting smaller as the finger or pen moves closer to the bridge of the nose. It's best to wait a second or two after shining the penlight before testing for accomodation, just because the pupils might already be constricted when you start if you don't wait. We were taught to check for equally round and reactive, then do the test of the ocularmotor muscles by holding the pen and moving it right to left and up and down, and then move it towards and away from the patient, just to give them that moment.

[LilyRN99]

Any tips for checking pupillary action in dark colored eyes? Hard to see pupil in the dark. I often see tiny pupils in the elders and find it difficult to determine if there is a reaction to light. Is that normal and hoe do you document it?