an overactive ciliary muscle, located in the middle layer of your eye.If your pupils aren’t responding to light or moving objects, it could indicate: Some examples of conditions that cause differently sized pupils include: However, one out of five people with no eye health problems have pupils that are normally different sizes. If your pupils have a difference of more than 1 millimeter in size (called anisocoria), or aren’t perfectly round, you may have an underlying condition affecting your brain, blood vessels, or nerves. The results of a pupil exam can indicate many conditions, depending on which part of the test was unusual. Pupils are equal, round, and reactive to light and accommodation. You can also think of PERRLA as a sentence. If your pupils are nonreactive to accommodation, it means they don’t adjust when you try to shift your focus to an object in the distance or near your face. Accommodation refers to your eyes’ ability to see things that are both close up and far away. If they don’t, there could be a problem affecting your eyes. When your doctor shines a light in your eyes, your pupils should get smaller. This step reminds your doctor to check your pupils’ reactions to the next two items in the acronym. Your pupils react to your surroundings to control how much light enters your eyes. Pupils should also be perfectly round, so your doctor will check them for any unusual shapes or uneven borders. If one is larger than the other, your doctor will want to do some additional testing to figure out why. They control how much light enters the eye by shrinking and widening. The pupils are in the center of the iris, which is the colored part of your eye. PERRLA is an acronym that helps doctors remember what to check for when examining your pupils.
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