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Quantitative Pupillometry Values Are Similar in Bright Light and Dim Light Conditions.

Kylie MacLean Hall1,2, Jennifer Wilson1, Ty A Johnson2

  • 1Address correspondence and reprint requests to: DaiWai M. Olson, PhD, RN, CCRN (DaiWai.Olson@UTSouthwestern.edu).Texas Woman's University, Denton.

Dimensions of Critical Care Nursing : DCCN
|May 28, 2026
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Adjusting ambient light is unnecessary when measuring the pupillary light reflex (PLR) with a quantitative pupillometer (QP). Studies show no significant differences in PLR measurements regardless of light conditions.

Area of Science:

  • Ophthalmology
  • Neuroscience
  • Critical Care Medicine

Background:

  • Current practices for measuring the pupillary light reflex (PLR) lack strong evidence regarding ambient light adjustment.
  • Quantitative pupillometry (QP) is increasingly used, necessitating standardized measurement protocols.

Purpose of the Study:

  • To investigate the impact of varying ambient light levels on quantitative pupillometer (QP) measurements.
  • To determine if bright light or darkened room conditions yield different results for pupil size and PLR.

Main Methods:

  • Light intensity was measured in an intensive care unit using a lux meter.
  • Paired-sample, within-subjects measurements of the pupillary light reflex (PLR) were taken using a quantitative pupillometer (QP) in alternating bright and dark conditions.
Keywords:
Cranial nervesCritical careNeurological examinationPupil assessmentPupillometer

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  • 32 healthy volunteers participated in the study.

    • Main Results:

    • No statistically significant or clinically relevant differences were observed in the neurological pupil index scores between bright light (mean = 561.5 lux) and dark conditions (mean = 0.9 lux).
    • Mixed-effects modeling confirmed that repeated observations did not alter the findings.
    • Pupil size was noted to be larger in dark conditions, but the pupillary light reflex remained functional.

    Conclusions:

    • The study provides evidence that ambient light levels do not significantly affect pupillary light reflex (PLR) measurements obtained via quantitative pupillometry (QP).
    • Nurses and clinicians do not need to adjust room light levels before performing PLR measurements with a pupillometer.
    • Findings support the reliability of QP measurements across different lighting conditions, simplifying clinical practice.