Hutchinson Pupil
Other Names
- Hutchinson pupil
- Hutchinson's pupil
- Unilateral fixed dilated pupil
- Ipsilateral fixed dilated pupil
- Third cranial nerve compression pupil
- Oculomotor nerve compression pupil
- Herniation pupil
Purpose
- Clinical exam finding that suggests life-threatening intracranial pathology
- Identify compression of the ipsilateral oculomotor nerve (cranial nerve III)
- Most classically this is due to pending or established uncal herniation, although the differential is much broader
Description
- Perform normal pupillary eye exam
- Normally, pupils are equal, round and reactive to lighht and accomodate
- Hutchinson's pupil
- Unilateral, dilated, poorly reactive or non-reactive pupil
- Can eventually assume a "down and out" position due to complete third nerve palsy
- Occurs ipsilateral to lesion
Pathology
- Intracranial Herniation
- Uncal herniation (classic cause)
- Transtentorial herniation
- Increased intracranial pressure
- Traumatic Brain Injury
- Epidural hematoma
- Subdural hematoma
- Cerebral contusion
- Diffuse cerebral edema
- Cerebrovascular Disease
- Intracerebral hemorrhage
- Massive ischemic stroke with cerebral edema
- Hemorrhagic transformation
- Intracranial Mass Lesions
- Brain tumors
- Brain abscess
- Metastatic lesions
- Large arachnoid cyst
- Vascular Disorders
- Posterior communicating artery aneurysm causing third nerve compression
- Cavernous sinus lesions
- Other Causes
- Severe cerebral edema
- Postoperative intracranial swelling
- Brain infections causing mass effect
Evidence
- Unknown
See Also
References
- ↑ Penney, Dawn C., Zoë M. Rushetsky, and Donald W. Penney. "Abnormal pupils at the bedside: rapid recognition of neurologic and systemic emergencies in acute care settings." International Journal of Emergency Medicine 19.1 (2026): 73.
- ↑ Skeik, Nedaa, and Fadi I. Jabr. "Migraine with benign episodic unilateral mydriasis." International Journal of General Medicine (2011): 501-503.
Created by:
John Kiel on 30 June 2026 19:05:39
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Last edited:
1 July 2026 02:50:02
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