Pupil dilation after retina detachment surgery

[Simonschu18]

4 weeks ago I had retina detachment surgery for a macula off detachment. I am a healthy 18 y/o male and my eye is healing really well with minimal drops, and my vision is already 20/40 in that eye. However, my pupil still remains very dilated, without the use of atropine ( last used 4 weeks ago.) My doctor says this is not normal "but expected" following my procedure. It was a 360 endorser vitrectomy with no freezing or buckle. I have an eye bulb in my eye (but 30% remaining). I know that the pupil dilation is caused most likely by thermal damage to the nerves that control the pupil, and that there is a slight chance it could be lingering effects from the atropine ( I have light blue eyes). If it is nerve damage, my nerves should try and repair, and in most cases ( as far as I know) the problem resolves between 1-6 months. I am starting college in 4 months and hope this will come sooner than later ( if it is not permanent enlarged where it is cosmetically noticeable). I have a couple of questions if someone would like to answer. First, if you had this same problem, how long, if at all, did it take for your nerves to heal. And if you are a doctor, what is the percent of patients that recover from this nerve damage ( I know you can't be specific but please estimate.) 2. I complained about the brightness from the dilation to the doctor and he gave me pilocarpine. I am reluctant to use them because of the stories I've read on here, so advice from that would be appreciated also.

[John C Hagan III, MD, FACS, FAAO]

You have many many posts and most cannot be answered without time passing. I would not use the pilocarpine either.  It will probably take 6 months to see how much your pupil returns towards normal size. sometimes it recovers completely, sometimes not.

[Simonschu18]

Thank you Dr. your a heaven sent with your quick and helpful input. I have one final question regarding this. If I use the pilocarpine, would that reverse the effects of any lingering atropine? That is the only reason I am considering using it, I also read on a similar website that sometimes the pupil can become spasmed or "shocked" following surgery and sometimes needs some help to work correctly. Would pilocarpine have any benefit this way? I know I've been a bother, thanks for answering me.

[John C Hagan III, MD, FACS, FAAO]

Pilocarpine can cause RD. It is contraindicated in many people including post RD surgery. DO NOT use pilo to conteract the effects of atropine. Let them wear off naturally.  Post many types of intraocular surgery, the pupil can be left larger than the fellow eye but pilo will not prevent this and can cause the pupil to become scarred in a too small position.

[Simonschu18]

ok thanks. A little update, my doctor is pretty sure my dilated eye is not from atropine, and is from nerve damage., I am approaching six weeks from surgery. My eye constricts a little in bright light, is this a good sign of its recovery? and second at what point would you consider safe to say that the atropine has worn off completely so I can try the pilocarpine. My doctor does not seem concerned about it causing another detachment because my detachment was a result of a football injury that caused a tear, and which went unnoticed and than caused the detachment 5 months after the injury. ( my pupil was working fine following the injury so it is not traumatic irdepogia either)

[John C Hagan III, MD, FACS, FAAO]

You will need to ask your surgeon.

[Simonschu18]

Doctor Hagan, I ended up trying the pilocarpine 1% 6 weeks after last use of atropine . It was not fun so not doing that again. But since my eye constricted, does that confirm that the atropine has worn off?

[Simonschu18]

Constricted with the use of pilocarpine not the consensual response to light, that is still not working.

[John C Hagan III, MD, FACS, FAAO]

I would say it confirms that most or all of the atropine has worn off as atropine is a stronger dilator of the pupil than 1% pilo is of a constrictor.   Sometimes the pupil recovers on its own some or all.  I tell people 6-12 months to know the final size.