To the Editor.—
Facial trauma frequently results in soft-tissue injury with edema and/or hematoma formation, leading to closure of the eyelids within a short time. Under these circumstances, evaluation of the condition of the globe may be difficult, and an accurate test of visual acuity may be impossible. This is especially true if there is a disturbance of mental function associated with the trauma or intoxication. Even though it may be impossible to lift the upper lid enough to visualize the globe because of tense swelling or local tenderness, one may evaluate the function of the optic nerve and retina by flashing a bright penlight onto the closed eyelids in a darkened room, observing the reaction of the opposite pupil. In a mirror, the clinician can demonstrate this on himself or herself by observing the reaction of the left pupil to a bright light flashed onto the closed right eyelid.
Klingele TG. Afferent Pupil Testing in Orbital-Facial Trauma. JAMA. 1984;252(11):1411. doi:10.1001/jama.1984.03350110017018
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