Pupil size

[ArleneB]

I had surgery for a detached retina 2 months ago.  I had the fluid drained, gas bubble  put in and the buckle around the eye.  I had a very large tear in my retina and this had to be repaired with a laser.  I now have a cataract which I am going to have surgery on next week.  The cataract will be removed and replaced with a lens.  The issue is my pupil that had the retina surgery will not contract down as small as the other eye.  I have uneual pupils now.  The question is why did this happen?  the doctor says it could be the laser and he doesn't know if it ever be the same as my other eye.  Does anyone have the answer?

[atlmissvertrauen]

The answers here have been very helpful, even better than Medscape. I was getting rather worried about the eye still being red...and seeing others state the same is a relief. I'm an RN, my doctors seem to often tend toward vague answers. Mine does fairly well with 99 questions but the one thing I'm not really finding is....how long on average does it usually take before the eye wants to stay open after retinal tear surgery? What mechanism makes it just stay shut like that? (try googling for that stuff.....) That answer about the drooping eyelid is worrying me. Its Halloween and I look the part. The eye stays closed unless its very dark and then only opens now and then half way. I had surgery 4 wks ago. What I'm looking for is when would be the time to start really worrying about it. They scratched the cornea on the nonsurgical eye during the procedure and I think that makes them extremely careful what they say.
I had what looked like a sideways jellyfish in just the edge of my vision, the surgery was the next am. Had the gas bubble, buckle entire thing. Hx of posterior subcapsular cataracts w surgery/lens about 9 yrs ago. Hx severe recurrent uveitis-at least half dozen times in a year...just in the retinal tear left eye-which stopped and never came back after the cataract surgery. ( yes I know its different parts of the eye...but there just had to be some connection). Hx inflammatory disorders. Age active 53,

[mike230]

The pros to the pursestring suture to make the pupil normal size is the quality of clarity in vision, the con is the inabliity to diolate to examine the retina.  My understanding is that the newest device optical coherent tomography (OCT) allows the opthamologist the ability to take detailed photos of the retina and optical nerves without diolating the pupil.  Thanks
Mike230

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

The fact that it's better in the morning is a good thing. Surgery rarely makes the eye a perfect match for the other eye. It usually makes it better.

By the way there are two muscles that open the eye the levator and Mueller's muscle. The latter is very susceptable to fatigue (why our lids droop when sleepy) sometimes over the counter drops like visine, napthcon or ophthcon can stimulate Mueller's muscle and make it better. Try using several drops in the PM when it starts to droop might help.

JCH III MD

[ArleneB]

Hi Doctor,

We talked about the droopy eyelid before, but I have noticed that when I get up in the morning the eyelid is almost exactly open the same amount as the right eye.  During the day it begins to droop, and by evening it is more noticeable.  My opthomologist said to wait six months and see if it improves.  There is a opthomologist plastic surgeon in the eye group that fixes this problem,  Do you think it may improve since it looks normal first thing in the morning?  If I decide to have it fixed what are the chances it will repaired to match the other eye?

Arlene  

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

Hello ArleneB  A scleral buckle actually make the eye longer (more myopic or nearsighted). It is far more likely that your lid is sagging (ptosis) as discussed in the conversation thread above.  Ask your surgeon to confirm this. It it's troublesome and its been 6 months you might see an oculo-plastic surgeon-ophthalmologist to discuss the possibility of surgical repair.

JCH III MD

[ArleneB]

Hi Doctor,

I have noticed after the retina operation, with the buckle in place my eye appears smaller than the left eye.  My eyes are prominent and the one with the buckle now looks smaller and less prominenet.  I am imagining this or is this real?

Arlene

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

Either or both surgeries can cause a droopy eyelid (ptosis). Most ptosis improves over a matter of 4-6 months post operative.  If after a half year its still droopy its not likely to make a recovery and you may need to see an ophthalmologist that specializes in eyelid surgery (oculoplastic surgeon) if it's a major problem.

JCH III MD Eye Physician & Surgeon

[ArleneB]

Hi Doctor,
had had
I have one retina procedure, one retina surgery and a cataract sugery.  These were done between May and July of this year. Now my eyelid droops,.  Will my eyelid return to it's original position?  If so how long could this take?

Arlene

[Ruqayyah]

yeah both eyes do. Okay thank-you

[John C Hagan]

If both eyes do it then its a normal adjustment to the amount of surrounding light or the eye's effort to focus. Also the pupil twitches a little "hippus".

JCH III MD Ophthalmologist

[Ruqayyah]

wen i look in the mirror i can see sometime that the black pupil in my eye grows larger but then sometimes goes back to original size. Is there something wrong wiv my eyes or is it a natural thing.

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

Yes it could be your astigmatism even a relatively small amount can blur the vision without glasses. However this should be easily corrected with glasses. When you go in tomorrow see if they will do a glasses test or refraction. That should determine whether if problem is astigmatism. If the vision clears with a correction in front of your eye for astigmatism-no problem. If it doens't then it may be a health or healing issue in the eye.

JCH III MD Eye MD

[ArleneB]

The only thing I know for sure is that when my retina detached it did not involve the macular area.  There is no cloudiness developed at this point behind the the implant (confirmed by the doctors),  Yes I am taking a steroid eye drops as I also did with the retina operation. I will be seeing the doctor again tomorrow as he wants to check on my pressure.  I will ask him about any swelling of the cornea and macula.  You did not mention that you thought it could be caused by my astigmatism.  I just hope the vision improves.  At least I can see and I am thankful for that!  I look forward to your reply.

Arlene

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

Hello Arlene,  Sorry, you've had a rough year. The most likely cause of the wavyness would be damage to the macula from the retinal detachment. When the retina detaches, especially if the macula is pulled off ("macula off retinal detachment") even if the retina is successfully reattached the retina and macula do not go back to mormal. Think of it this way. If you had a 8 X 11 photograph and you took it and crumpled it up to the size of a lemon, then you laid it down and tried to smooth it out you could never make it completely back to normal and remove every crease and/or wrinkle.

You will need to get this clarified by your cataract and retinal surgeon. If this is the cause you may not achieve the type of vision you had before the retina detached and the cataract developed.

There are some things related to the cataract surgery that might be the cause (that would be a better thing) such as swelling of the macula (cystoid macular edema), cloudiness of the capsule behind the implant, swelling of the cornea.  Those often get better with time.

There are also several reasons why your intraocular pressure (IOP) may be up: inflammation in the eye, a pressure reaction to the steroid eye drops you probably are on would be the most common.

Time will tell your final result but your cataract and retinal surgeon can give you an idea of what your macula looks like.

Hope it turns out well.

JCH III MD    Eye MD = Ophthamologist

[ArleneB]

I had the ctararct surgery on 7/26.  My lens is for reading with an 18 inch focal distance.  I wear a contact lens in my right eye for distance.  I did this because I have worn mono visioncontact lenses for over 10 years successfully.  Now my readinging vision is not good.  Lines are wavey and do not appear staright.  Words on the pages are difficult to read, almost as if the letters are moving as I try to read them.  Today I went back to see the doctor and I discovered that my eye pressure is 28 in the operated eye.  The doctor said that this may be causing the problem.  I also have an astigmatism.  What could be causing the eye pressure problems and wavely lines.  I am now on drops and diomox to lower the  pressure.  I had retina surgery in May , which I already wrote to you about.  I look forward to your reply.  Thank you.

Arlene

[ArleneB]

I had the ctararct surgery on 7/26.  My lens is for reading with an 18 inch focal distance.  I wear a contact lens in my right eye for distance.  I did this because I have worn mono visioncontact lenses for over 10 years successfully.  Now my readinging vision is not good.  Lines are wavey and do not appear staright.  Words on the pages are difficult to read, almost as if the letters are moving as I try to read them.  Today I went back to see the doctor and I discovered that my eye pressure is 28 in the operated eye.  The doctor said that this may be causing the problem.  I also have an astigmatism.  What could be causing the eye pressure problems and wavely lines.  I am now on drops and diomox to lower the  pressure.  I had retina surgery in May , which I already wrote to you about.  I look forward to your reply.  Thank you.

Arlene

[John C Hagan]

This is a generalization but it usually improves with time but on close inspection the lumpy areas can still be identified. Ask your retina surgeon about this next visit.

JCH MD

[ArleneB]

Thank you for the information.  I cannot see the buckle.  What I do see , are the scars on the white part of my eye near the inner corner towards my nose.  The whitre part looks lumpy.  Will it stay that way?  Or will it smooth out? I appreciate all the answers you have given me.  

[John C Hagan]

The retinal detachment operation is a BIG operation on very vascular tissue and persisting redness is a frequent complaint (including in this forum). The eye should continue to whiten for up to 3-4 more months. If you look carefully especially looking to the side you may be able to the encircling element (the 'buckle") around the eye, you may be able to see the stitches used to anchor the buckle and the stitches used to close the sclera where the instruments were placed in your eye for the vitrectomy. This "hardware" is permanent and if that's what you're seeing it will be there "for good".

Please reallize that you are much more aware and conscious of these than the people you come in contact with. I hope you cataract surgery goes well also. It's much less of a stress on the eye that your pervious procedures.

JCH MD  Fellow American College of Surgeons

[ArleneB]

It sounds like I am going to have unequal pupils permananetly
My eye is still slightly red, definite;y not as white as my right eye.  Will that imprIve with time?  Also I can see the scars in the white of my eye and I am wondering if that will eventually go away?   When I had the operation I asked my doctor if the eye would eventually look the same as the right eye, he said yes.  Now I am finding out that this will not happen.  I am lucky I can see.  I hope the cataract operation goes well.  I look forward to your response.

[ArleneB]

t sounds like I am going to have unequal pupils permananetly
My eye is still slightly red, definite;y not as white as my right eye.  Will that imprIve with time?  Also I can see the scars in the white of my eye and I am wondering if that will eventually go away?   When I had the operation I asked my doctor if the eye would eventually look the same as the right eye, he said yes.  Now I am finding out that this will not happen.  I am lucky I can see.  I hope the cataract operation goes well.  I look forward to your response.

[John C Hagan]

Pupil abnormalities, especially a pupil larger than the other side and sometimes a large pupil that does not constrict at all, can occur as a complication with most types of surgery within the eye. The reason for this is that the nerves that go to the pupil run within the layers of the eye going from the back to the front. In retinal detachment surgery any number of things from laser, manipulating the eye muscles, applying freezing (cryotherapy), draining the fluid under the retina can cause damage to the pupil. In other types of surgery such as cataract and corneal surgery the problem usually occurs due to direct trauma to the iris. Another common cause is increased pressure pre- or  post-operatively within the eye can damage the pupil nerves.  These problems connot be avoided in most cases because the nerves to the pupil cannot be seen from look in the eye or looking on the outside of the eyeball and or to repair the problem in the eye requires laser/freezing right over the nerve.

It is possible you might see some improvement but 2 months is a long time and it is possible it will never be the same size or work as well as the other non-operated on eye. The pupil should not cause any problem with cataract surgery or insertion of an implant.

In terms of what you do about this your options are limited. If sensitive to light sunglasses, photochromic lens (Transitions, Photogray, etc) and a hat can help outside, even sun goggles. There are drops to constrict the pupil but they can have side effects especially in a person with retinal detachment and the pupil would always be small and not move naturally. People with a "blown pupil" so dilated the iris/pupil almost looks completely black and who are disabled by the glare and photophobia may elect to have a purse-string stitch put in the iris opening to pull it down to a smaller size. Again the pupil doesn't move, it's always the same size and this can make checking your retina difficult.

An occassional patient with this problem has found tinted contact lens helpful.

JCH MD Eye Physician & Surgeon    (Ophthalmologist = Eye MD)