PERRLA (pupils equal, round, reactive to light and accommodation)
PERRLA stands for pupils equal, round, reactive to light and accommodation. It is a charting shorthand for what an examiner saw when checking the pupils.
How to read it
Each letter is one observation: both pupils the same size (equal), round, getting smaller when light shines in (reactive to light), and getting smaller when the eyes focus on something near (accommodation). The textbook Clinical Methods describes those responses: pupils constrict to direct light, and both constrict when the eye focuses on a near object. Duke Health’s guide for patients reading their notes and California Correctional Health Care Services expand PERRLA the same way; Charleston Area Medical Center writes “accommodate” for the last word.
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These pages explain what medical abbreviations and symbols stand for. They are not medical advice and give no doses: a pharmacist or prescriber can explain what any label means for you.
PERRL, PEARL and PERL
Shorter versions leave out a letter or two. The Central California EMS Agency lists PERRL, “pupils equal, round, and reactive to light”, without accommodation. North Carolina’s EMS list has PEARL, “pupils equal and reactive to light”, and California Correctional Health Care Services has PERL with the same meaning.
What the shorthand leaves out
Robert H. Spector, writing the chapter on the pupils in Clinical Methods (1990), calls PERRLA “a convenient but incomplete description” of how the pupils work. He notes that it leaves out the actual size and shape of each pupil, how fast and how far each one constricts, and the result of testing for an afferent pupillary defect.
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Sources
- The Pupils (Clinical Methods, 3rd edition, chapter 58), Robert H. Spector, in Walker HK, Hall WD, Hurst JW, editors; Butterworths, 1990, NCBI Bookshelf (U.S. National Library of Medicine), Definition
- Common Medical Abbreviations you may encounter when reading your notes in MyChart, Duke Health (Duke MyChart), P
- Abbreviations Approved for Medical Records, Charleston Area Medical Center, P
- Approved Abbreviations, Clinical 2022, Health Care Department Operations Manual, California Correctional Health Care Services, P
- Approved Medical Abbreviations, Appendix G, revised 15 October 2023, North Carolina College of Emergency Physicians, via the North Carolina Office of EMS, P
- Accepted Abbreviations List, CCEMSA policies and procedures, general, Central California EMS Agency (Fresno County Department of Public Health), P
Last reviewed September 30, 2026 by Rory Hansen. How we research