title: Modified upgaze technique for pupil examination.
abstract: Assessing pupil reactivity using the swinging flashlight technique in patients with miotic pupils or heavily pigmented irides can be difficult due to the reflection of the examination light off the cornea. We describe a modification of the standard method of detecting pupil reactivity in these difficult-to-see pupils. With the patient facing forward and eyes looking in maximal upgaze, fixed at distance, the examiner shines the light at the limbus in the straight ahead direction. Improved view of the pupil in upgaze results from reduction of the blink reflex and elimination of the Purkinje-1 image with minimal refractive distortion by the cornea. Optical calculations and multimedia demonstrations are provided to document these findings.
authors.affiliation: Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Hsu
authors.forename: Mitchell P
authors.initials: MP
authors.lastname: Weikert
authors.forename: Rod
authors.initials: R
authors.lastname: Foroozan
mesh_terms: D000328:Adult; D003941:Diagnostic Techniques, Ophthalmological / Q000639:trends*; D005260:Female; D006801:Humans; D007498:Iris / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation / Q000379:methods*; D010808:Physical Examination / Q000379:methods*; D011681:Pupil Disorders / Q000175:diagnosis* / Q000503:physiopathology; D012025:Reflex, Pupillary / Q000502:physiology*