Advancements in medical technology offer health care providers the tools needed to deliver high quality health care and the means to generate improvements in the quality of that care. The automated pupillometer device is an advanced assessment device that may significantly improve the accuracy and reliability of pupillary assessments. For patients with life-threatening neurologic complications, more reliable pupillary assessments may lead to lower rates of morbidity and mortality. However, more research is needed to determine the effect of pupillometers on health outcomes. The purpose of this systematic review was to examine the effect the pupillometer has on the accuracy and reliability of the pupillary assessment in comparison to traditional, manual assessments. Polit and Beck’s guidelines for developing a research question and conducting a literature review were followed. Additionally, Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were observed and all required elements were incorporated in the review. The strength and validity of each study was evaluated following the Critical Apraisal Skills Programme (CASP) Cohort Study Checklist, which allowed the reviewer to employ a standardized, consistent, and reliable appraisal method. Using data collected in tables formulated by the author of this review, a cross study analysis was completed whereby the studies were analyzed for emerging trends, patterns, and themes. The pupillometer was found to provide a more accurate and reliable measure of both pupil size and reactivity as compared to the traditional assessment tools such as using flash lights and the naked eye to estimate pupil size and reactivity. By incorporating the use of the pupillometer device in routine monitoring of patients at risk for neurologic deterioration, the danger of undetected life-threatening changes in condition may be reduced.