Objective:

To review the history of the automated pupillometer leading to its use in the Neurocritical Care Unit.

Background:

Pupillary examination is an essential component in the assessment of patients with neurological conditions. An automated pupillometer is a device used to objectively measure the pupillary size, symmetry, and light reactivity. Multiple studies support its superiority compared to routine penlight pupillary examination by eliminating variability and subjectivity. 

Design/Methods:

We conducted a literature review using JStor, PubMed, and Google Scholar. 

Results:

Our understanding of the pupillary exam was first described by Claudis Galenus in the second century CE. The first pupillometer was invented by Helmholtz (1821-1894), a German physician and physicist. Visualizing pupillary changes using infrared light was first used in 1958 by Lowenstein and Loewenfeld. The first automated infrared pupillometer was invented in 1962. The first portable infrared pupillometer was created in 1989; however, it was not readily available in the hospital setting. One of the earliest studies on automated pupillometry in the ICU setting was conducted in 1995 by Larson. Infrared smartphone pupillometers were first investigated in 2013 and are of ongoing investigation. In 2015, the first time pupillometry data was implemented into the electronic medical record. The advancement in pupillometer technology has allowed it to become a valuable tool in clinical decision-making and as a prognostic indicator in the neurocritical care unit.

Conclusions:

The development of innovative technologies applied to the fundamentals of clinical examination expands the horizon for more precise and accurate patient management and improved outcomes.