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Describing Anisocoria in Neurocritcally Ill Patients

Author(s): Ciji Saju, MSN, RN, CCRN, CNRN, Arianna Barnes, DNP, RN, ACCNS-AG, CCRN, PHN, Joji B. Kuramatsu, MD, Jade L. Marshall, BS, Hirofumi Obinata, MD, PhD, Ava M. Puccio, PhD, RN, Shoji Yokobori, MD, PhD, DaiWai M. Olson, PhD, RN

Contact Hours 1.00

CERP A 1.00

Expires Nov 01, 2026

Topics: Neurology, Quality Improvement

Population: Adult

Member: Free
NonMember: $10.00

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Activity Summary

Required reading for all learners: Implicit Bias impacts patient outcomes

Evaluation of the pupillary light reflex (PLR) is part of the standard neurologic assessment for patients with known or suspected intracranial pathology. Quantitative pupillometry (QP) is expanding clinical science research on PLR beyond the assessment of neurocritically ill patients. Anisocoria, the absolute difference in left and right pupil diameter (pupil size), has been suggested as an important clinical biomarker. However, the definition of anisocoria is imprecise. Little evidence describes how QP can help define anisocoria and assess neurologically ill patients for anisocoria. Nurses, more than members of other professions, are tasked with frequent assessment of patients with neurologic injury.


  • Describe the advantages and disadvantages of using quantitative pupillometry to evaluate the pupillary light reflex.
  • List the various pupil size difference cutpoints used to define anisocoria.
  • Discuss the implications of after-light stimulus anisocoria as a novel biomarker of brain injury.

Continuing Education Disclosure Statement

Successful Completion

Learners must attend/view/read the entire activity, read Implicit Bias impacts patient outcomes, and complete the associated evaluation to be awarded the contact hours or CERP. No partial credit will be awarded.


The American Association of Critical-Care Nurses is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Provider approved by the California Board of Registered Nursing, Provider number CEP 1036, for 1.00 contact hours.

Accreditation refers to recognition of continuing education only and does not imply AACN, ANCC, or CBRN approval or endorsement of any commercial products discussed or displayed in conjunction with this educational activity.


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