How to Assess Eyes for PERRLA: Nursing Skills

To assess reaction to light, shine the pen light from the side of one eye and observe its constriction. Then, repeat this on the same eye but observe the consensual reflex in the opposite eye, which should also constrict to the same degree. This process is then repeated for the other eye.

Accommodation is assessed by having the patient look at a distant object and then bringing their focus to a close object (like a finger in front of their nose). The pupils should constrict and the eyes should converge (move inward). The video notes that the pupil size change during accommodation can be subtle.

The video introduces the pupil assessment known as PERRLA, highlighting its importance in acute care. The instructor emphasizes that this is a basic and vital assessment that should be performed on every patient to gather crucial information.

PERRLA stands for 'Pupils Equal, Round, Reactive to Light, and Accommodation'. The video breaks down each component, explaining that pupils are the dark colored part of the eye that control light entry and should be equal in size and shape. Unequal pupils (anisocoria) exceeding 1 millimeter difference, or non-round pupils, can indicate pathology.

A pen light is the only equipment needed for the assessment. Before shining the light, it's advised to observe the pupils' initial size. It may be helpful to dim the lights or use a piece of paper to reduce reflections and see the eyes better.

When documenting, record the initial pupil size followed by the constricted size (e.g., '3/2 both eyes'). The video reiterates the importance of performing PERRLA often, as it provides vital information about the patient's nervous system, blood supply, and brain.