Coma.

Abstract

Comatose patients are unresponsive to all external stimuli, noxious or otherwise. Neuro-ophthalmic techniques are paramount in the neurologic assessment of comatose patients, especially with regard to brain stem localization and diagnosis. Examination of the pupils, fundi, and corneal reflexes are all helpful; however, the ocular motility examination is especially important because the pathways governing ocular motility traverse the entire brain stem, so pathology in this region often produces recognizable eye movement abnormalities. Conversely, if the eye movements are all normal, it is likely that the entire brain stem is normal. This article details the pupillary, eye movement, and funduscopic abnormalities in coma.