Pupillary signs in a comatose patient

Pupil characteristics can be used to identify the cause of coma in a patient. It also helps in determining the treatment. The important pupillary signs are given below:

Pinpoint pupilsPontine lesion / morphine poisoning
Moderately dilated, non reactive, fluctuatingMid brain lesions
Unilateral dilated, non reactiveThird nerve damage – due to transtentorial herniation of temporal lobe / traction of third nerve against posterior cerebral artery
Bilateral dilated, non reactiveTerminal states / Ischemic brain damage / Atropine / Belladonna poisoning
Small, equal, reactiveToxic / Metabolic causes of coma

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