The Pupillary Responses After Being Struck by Lightning

To the Editor.—  This letter concerns the article by Amy and colleagues¹ that appeared in the Jan 11, 1985, issue of The Journal regarding lightning injuries.In the article, the reliability of a critical observation that would be made by any practitioner involved in the initial evaluation or resuscitation of the patient injured by lightning goes without mention. I am specifically referring to the reliability of pupillary responses used to evaluate the probable degree of brain-stem hypoxia.It has been well documented that transient or permanent autonomic disturbances involving ocular function may occur following a lightning injury. These disturbances include mydriasis, anisocoria, Horner's syndrome, failure of accommodation, and loss of the red reflex.^2-4This phenomenon is well known to emergency physicians and others who are called on to evaluate the victim of lightning strikes.It therefore becomes important for all clinicians to know that dilated or nonreactive pupils are