Pupillometry: a non-invasive technique for pain assessment in paediatric patients

Mark A. Connelly, Jacob T. Brown, Gregory L. Kearns, Rawni A. Anderson, Shawn D. St Peter, Kathleen A. Neville

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


OBJECTIVE: Pupillometry has been used to assess pain intensity and response to analgesic medications in adults. The aim of this observational study was to explore proof of concept for the use of this technique in paediatric patients. Changes in pupil parameters before and after opioid exposure also were evaluated.

DESIGN AND SETTING: This was a single-centre, prospective study conducted at an academic paediatric medical centre.

PATIENTS: Children 9-17 years of age undergoing elective surgical correction of pectus excavatum were enrolled into a protocol approved by the human ethical committee (institutional review board).

INTERVENTIONS: Pupil size and reactivity were measured using a handheld pupillometer. Pain was assessed using age-appropriate, validated pain self-report scales.

RESULTS: Thirty patients were enrolled. Each point change on a 10 cm visual analogue pain intensity scale was associated with a statistically significant mean change of 0.11 mm/s in maximum pupil constriction velocity, and of approximately 0.4% in pupil diameter. As expected, there was an association between total opioid dose (expressed as morphine equivalents) and pupil diameter. Age, sex and baseline anxiety scores did not correlate significantly with pupillary response.

CONCLUSIONS: The association of maximum pupillary constriction velocity and diameter with pain scores illustrates the potential for using pupillometry as a non-invasive method to objectively quantitate pain response/intensity in children. The technique holds promise as a pharmacodynamic 'tool' to assess opioid response in paediatric patients.

Original languageEnglish (US)
Pages (from-to)1125-1131
Number of pages7
JournalArchives of disease in childhood
Issue number12
StatePublished - Dec 1 2014

Bibliographical note

Publisher Copyright:
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.


  • Analgesia
  • Pain
  • Pharmacology
  • Technology


Dive into the research topics of 'Pupillometry: a non-invasive technique for pain assessment in paediatric patients'. Together they form a unique fingerprint.

Cite this