"Pearl Eyes" in Cardiac Arrest: Paramedic Sign of Prior Asystole/PEA

"Pearl eyes" describe a bluish-white, opaque discoloration of the eyes observed in resuscitated cardiac arrest patients. This sign results from retinal ischemia—absence of perfusion pressure in the central retinal artery during prolonged asystole or pulseless electrical activity (PEA).

Clinical Significance

• Indicates the patient experienced a period of zero or near-zero cerebral perfusion pressure prior to ROSC (Return of Spontaneous Circulation).
• Correlates with poor neurological prognosis, though not deterministic alone.
• Seen in context of other post-ROSC signs: fixed/dilated pupils, absent corneal reflexes, myoclonus.

Paramedic Documentation

Record "pearl eyes" or "retinal ischemia signs" in the PCR (Patient Care Report) with time noted. Communicate to receiving ED/hospital team as part of post-cardiac arrest handoff (e.g., SBAR).

Note: This is a physical sign, not a diagnostic test. It supports clinical impression of prolonged downtime but does not replace multimodal neuroprognostication (EEG, NSE, MRI, clinical exam at 72h).