Pupillary assessment was an important method for monitoring the condition of critically ill patients.Ultrasound-guided pupillary assessment overcome the limitations of traditional methods and provides accurate evalua-tion for patients who are unable to open their eyes due to traumatic brain edema and periorbital soft tissue edema,and helped facilitate timely and accurate clinical observations,and enabled objective monitoring of the level of anal-gesia.This review article aimed to provide an overview of the application,progress,and limitations of ultrasound-guided pupillary assessment in ICU,with the intention of offering objective evidence and references for the clinical diagnosis,treatment,and nursing interventions of critically ill patients.