Evaluation of Ocular Signs in the Comatose Patient: A review of the literature
DOI:
https://doi.org/10.51437/nj.v31i1.457Palabras clave:
Ocular motility disorders, Pupil disorders, Coma, Disorders of consciousnessResumen
Introduction: The Ascending Reticular Activating System (ARAS) is responsible for maintaining consciousness. This network traverses the brainstem and has multiple projections to the cerebral cortex. The ARAS is anatomically related to the oculomotor and optic nuclei; therefore, when affected, certain ocular signs should be evaluated. During the neuro-ophthalmological assessment of a patient with a consciousness disorder, pupils, eye movements, and oculocephalic reflexes should be explored to locate the lesion and its etiology (toxic, metabolic, or traumatic). This manuscript aims to review the most notable characteristics of evaluating ocular signs in comatose patients.
Methods: This work consists of a review of scientific literature related to the evaluation of ocular signs in comatose patients. An exhaustive search was conducted on PubMed, Scopus, and Web of Science. Studies providing relevant information on the evaluation of ocular signs in patients with consciousness disorders were selected.
Results: Several ocular signs were identified that may indicate involvement of the ARAS, such as changes in pupil size and reactivity, restrictions in eye movements, and abnormal responses to oculocephalic reflexes. These findings can assist physicians in locating the underlying lesion and determining its etiology, thereby facilitating appropriate clinical management.
Conclusions: The assessment of ocular signs in comatose patients is a valuable tool in clinical practice. Early recognition of these signs can enable swift and accurate interventions to treat life-threatening injuries. Further studies are needed to validate the efficacy and accuracy of these signs in the diagnosis and management of consciousness disorders.
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