In one patient (3), it later transpired that the cause of the enlarged, poorly reactive pupil was an afferent defect in that eye due to a fracture at the optic canal, injuring the optic. It may also represent herniation of the uncus of the temporal lobe. Three patients (9) had direct trauma to the eyeball, causing traumatic mydriasis: in one case the trauma was so severe that the globe was later exenterated. The classic fixed and dilated "blown pupil" is a unilateral phenomenon that may occur when a rapidly expanding intracranial mass, including blood from a hemorrhage, is compressing cranial nerve III. Mydriasis also may be an effect of adrenergic stimuli such as epinephrine, anticholinergics, cocaine, PCP, and drug withdrawal. This may reflect compression or distortion of the oculomotor nerve by either primary injury or herniation. Pupillary dilation ( mydriasis) indicates unopposed sympathetic activity due to impaired parasympathetic axons. It is an important clinical sign in physical diagnosis, especially in emergency department or intensive care unit patients, where it can signal a stroke, impending brain herniation, or other brain catastrophe. Overviewīlown pupil is an informal medical term used by physicians and nurses to refer to sudden pupillary dilation and loss of ability to constrict in response to light. Pupil dilated using anaesthetic and muscle relaxant. Risk calculators and risk factors for Blown pupil US National Guidelines Clearinghouse on Blown pupilĭirections to Hospitals Treating Blown pupil ![]() Ongoing Trials on Blown pupil at Clinical Īrticles on Blown pupil in N Eng J Med, Lancet, BMJ
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