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Traumatic Mydriasis, need help

Hi everyone. I have what seems to be a traumatic mydriasis from blunt trauma to my right eye that happened back in the middle of December.

My history:
Middle of December I took a slapshot to the eye from a rigid PVC hockey ball (wasn't wearing a cage). I immediately lost vision in my right eye. I was rushed to the hospital and determined to have a hyphema. The only thing I could see was light. The next day, the doctors could not get an accurate pressure reading on my eye so they decided to perform an "exploration of the eye" surgery, and found out that I had no tears or ruptures. The day following the surgery, and this is a big part, I was checked out by the doctor and he said when he shined the light into my eyes, my pupil was reacting, so that was a great sign that my nerve was working. I was given Atropine to take 2x daily and Prodnolisone to take 4x daily. I am 25 years old, so you can gauge my healing capacity.

Since then, I was on bedrest for about 2 weeks, staying on the atropine during this time. I was seeing an opthalmologist every few days. The hyphema eventually reabsorbed and I regained vision in my eye. I d/c'd the atropine after 2 weeks of being on it, but stayed on prodnolisone for about another 2 weeks thereafter. About a month after the initial hit, now middle of December, I still had a mydriasis, probably around 8mm when compared to the chart. Bad photophobia, poor visual acuity, everything. I was prescribed Pilocarpine 1% to take 4x daily. Within the first dose of this, my pupil had constricted and I could see much more comfortably. I stayed on this for a week and upon dc'ing the pilocarpine, my pupil had gone back to full size within about 36 hours. I have been off all medication now since that time, seeing my doctor here in a week.

During the course, the doctors all thought I was still under the effects of Atropine, since there did not appear to be any tears in the iris muscle that were noticeable, and that was the best explanation for my very dilated pupil. Now that my entire history has been explained, is it POSSIBLE that since my pupil was reacting to light just 2 days after the surgery, and now doesn't react at all, that the atropine dilated the pupil beyond its normal range of travel and tore a muscle in the iris somewhere? I just don't understand how it was reacting to light initially after the trauma, but now is so unreactive and open. This has been an emotionally taxing ordeal and I'd like to understand where I go from here, or if the atropine may have caused me this permanent state of discomfort with my eye.

Thanks to anyone that can offer assistance, but if not, I hope any searchers with similar issues may be able to benefit from this post.
304 Responses
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177275 tn?1511755244
It sounds like you and your ophthalmologist have a plan. These cases are so individualized that I cannot cite any useful experience. Hope it works. JCH MD
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Avatar universal
Hi, robsonvf,

congrats on your progress. I am really glad that you are on a good way of recovery. I hope you all the best.

I am still struggling with the mydriasis everyday, since it just won't get better. My pupil is about 6.6mm and there has been hardly any improvement in last months. The pupil is showing very small reaction to light, but it is very limited. The good eye has now a very small pupil (1.6mm). The pressure is also instable. The most frustrated thing is, that no one can tell me exactly, what is happening within my eyes.

I am trying to get Alphagen-P (must be imported, since it is not available in Germany) and also waiting for my iris print lens. I desperately would like to do things I used to do. But currently I am just not able to.

regards
Dapeng
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711220 tn?1251891127
MEDICAL PROFESSIONAL
I doubt the blow out fracture is a cause of the dilated pupil.

Dr. O.
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Avatar universal
If you'd like a second opinion, the Cincinnatti Eye Institute in Ohio houses some of the best surgeons in the world that deal specifically with pupil function.
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Avatar universal
Thanks, bad eyes.  For right now I'll sit tight and hope for the best, and if it looks like I've lost function I may have to give them a look.
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Avatar universal
As an update to any using this thread as a reference, I have been on Pilocarpine for the last month.  Sometimes I use 0.5%, sometimes I use 1%.  The 1% lasts longer but it also overly constricts my pupil sometimes.  At any rate, it does bring the pupil size down but once it starts to wear off, my pupil gets larger and I have more problems focusing near, and have big problems with bright objects.  Thus, it's important for me to keep the pupil size down.  For some reason, my injured eyes sees colors more vividly than my uninjured eye, even when the pupil is very constricted.  When both pupils are the same size, for some reason my injured eye seems to see bright colors brighter than my uninjured eye, while darker colors it sees darker.  I suspect this to be an effect of the pilocarpine to explain the darker colors.  The brighter colors, so far no doctor has been able to explain to me, since the pupils are the same size and thus should be filtering the same amount of light.

I have read on another thread here that acupuncture has helped another case of traumatic mydriasis.  I am not sure if it will help me, but I am going to try, because they claim that acupuncture realigns the body and helps it heal to its fullest potential, and that's what I am hoping for, to heal.  I have found a local doctor in the area that specializes in acupuncture in the eye area.  I am hoping this will render the best results reasonable.

I am not considered an ideal patient for the iris cerclage suture procedure because my original lens is still clear without cataracts, and performing the surgery would risk damage to the lens, causing a possible cataract.  This procedure seems to be favored when performing  cataract surgery, performing both at the same time.  So as of right now, it's pilocarpine and hoping for the best.  

I would like to inform those reading that the "exploration of the eye" procedure has caused me more problems.  I have excessive redness/bloodshot on one side of my eye where the blood vessels have all come together (looks bad, everyone notices it instead of the pupil), conjunctiva that is no longer bright white, irritated eyes, and problems wearing contacts.  Thi problem cosmetically is more noticeable than my pupil when  it's full.  Everyone notices the red eye.  I understand that this surgery is done to rule out life threatening injuries that could lead to infections, but if I were in any stable state of mind and the doctors didn't just tell me "it'd heal in a day," I would've never agreed to the procedure, since they had actually gotten a pressure reading of 20 through a different means of testing.  My problems now are twofold rather than just dealing with the mydriasis itself.  Anyway, I think readers should know this, and I wish I had, when the doctors had nonchalantly suggested they should perform the surgery.  My eye has been a nightmare to look at since, and honestly a little painful at times.

I know this is not a commonly documented injury due to the limited resources I could find online, so I will be sporadically updating the events that follow.  I only hope that my misfortune and documentation of my recovery will help any of those that find themselves in a similar situation, or prevent some of those from putting themselves at risk for this type of injury.  
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Avatar universal
Thanks for taking the time to do this post.  I recently got hit in the eye with a squash ball and have pretty much the same experience that you have outlined above.  I am now about one month on, and still have mydriasis in the injured eye.

This has been the most informative post I have found so far.  Understanding that at this stage the mydriasis is not considered permanent and that there are some treatments available is good news.

Due for my follow-up appointment this week, so I will post again to let you know.

Thanks again.
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Avatar universal
been back to the eye doctor today and been given the all clear.  Dispite the pupil still being dilated he has told me that there is no permanent damage expected. They pupil is expected to return to normal in the next few months.  Great news for you.  I was worrying for no reason.

All the best to everyone out there - remember to put the goggles on next time you play!
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Avatar universal
Toby, that sounds like a promising prognosis from the doctor.  Does your pupil have any reactivity to light?  Mine has none, even though they find no damage to the sphincter muscle of the iris.  I think they believe it to be neuronal damage.  
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Avatar universal
Update to any readers.  I have been trying acupuncture for about the past 5 weeks, treatments 2x a week.  This involves needles in my feet, hands, eyebrow, and 3 into my orbit.  My acupuncturist is very experienced with treating eye diseases that require these special placements so although I don't have anything to compare to, he seems to know what he's doing and surprisingly can get the needles around my eye without much pain, sometimes with none at all.  This has so far yielded no results.

I have also tried homeopathic means with a naturopathic doctor, for the past week, using symphytum and arnica.  No results as of yet there, either.
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Avatar universal
I had a similar injury to you. I was hit in the eye with a field hockey stick during another player's back swing. I had a fractured nose, orbital socket, a hyphema which caused total vision loss for several hours and traumatic mydriasis. My pupil was non reactive for several months after the injury and was very large. I was worried that it would never heal but after around 6-7 months it gradually got better to the stage now where is it reacting to light, just not as quickly or effectively as the other pupil. I had ordered a custom made, hand painted lens to reduce the photophobia and to improve the look of my eye. I'm hopeful that it will continue to improve. Good luck- I hope yours begins to improve also.
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Avatar universal
Thank you for taking the time to read my post and respond.  That gives me a great amount of hope. :)  Unfortunately my hyphema led to vision loss for about 3 days so I may have had slightly more trauma within the eyeball itself but I'm glad to hear yours was just as bad and now actually responds to light.  I'll continue to get my healing treatments and hope for the best!
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Avatar universal
I was hit in the left eye with a tennis ball towards the end of 2007.  Angle recession, trauamtic mydriasis and retinal scarring occured.  Ophthalmologists told me different things about the scarring and pupil dialation.  Some said the dialation wouldn't be permanent, others said that the scarring would not be permanent.  I have a blind spot from the retinal scar and my pupil has gradually become more responsive to light.  It has not improved completely yet.  I can't remember how long, but for the first while after being hit I had no response to light (maybe a month or two).  I am writing this post because I have decided to pursue knowledge of eye conditions and advance awareness as I  become an optometrist.  I have been researching treatments online for traumatic mydriasis (like you have I'm sure) and have found nothing promising that would bring the muscle functioning back to normal.  When I learn more or find something new I will post it.  Until then, keep your sunglasses on!
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Avatar universal
Just another update everyone, though no real progress to update.  I'm confident to say that the grieving period has come to a close and life is resuming to a new level of "normal."  I'm back to acting like myself and accepting what happened, which honestly is a big part of the healing process.  This entire ordeal has been emotionally exhausting above all else.  Obviously my daily routine has changed with Pilocarpine drops taken about 2-3 times a day at 0.5% strength, which wear off about 3 hours after use, where the pupil start to open back up.  Also, since I've always needed corrected vision, I can no longer wear my contacts for long periods of time because they just get uncomfortable, so I wear glasses most of the time now.  It's harder to get my prescription right in the eye, since the prescription changes with how dilated the pupil is.  I have tried many types of homeopathic treatments, lots of different vitamins, and all other means listed from posts above.  Now I have just come to accept the condition and though I have not lost hope, I feel it's easier to make the best of everyday without taking progessive measures to fix the eye.  I'm out of options, other than surgery.  It's easier on the mind to not get hopes up to be let down everytime, too.

So, to anyone reading this who has recently been hit in the eye and has a mydriasis, get on vitamins asap, and if you're having a tough time dealing with the injury emotionally, consider an SSRI with your doctor just to help out with the situational anxiety or stress.  Being positive helps the body heal better, and just being honest, though I do wish my eye were healed, this isn't that bad.  I've learned to live with it and I'm sure any strong-willed person will be able to, as well.  Mornings are just a little brighter until the drop sets in.  I'll continue adding to this post if anything changes, but until then, take care of yourselves, and wear eye protection.
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Avatar universal
the same thing happened to me, two weeks ago i was hit in the eye with a woofle ball bat..i had hyphema and was put on the prednisone drops..my right eye which is the injured one is still dilated, im hoping this goes away within time, my doctor said from my checkup the other day things are improving..my pupil still slighty reacts and gets a tad smaller when in the light but not as small as the uninjured one..im thinking about taking those pilocarpine drops, do they work well to make the pupil look smaller or at least somewhat similiar to the other one?
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Avatar universal
Hi Nik.  I'm not a doctor but I will offer my personal opinion in response to your question about Pilocarpine.  I would not even consider starting to take it right now, and I assume your doctor would agree with me.  You risk a detached retina with Pilocarpine and after the trauma that your eye has sustained, it needs time to heal.  If your eye is reacting to light, you have a lot to be thankful for.  The Pilocarpine will essentially paralyze your pupil in a fixed small state, often "overshooting" the effect you're looking for, and becomes much smaller than your other pupil, looking weird.  Pilocarpine is by no means a magic medicine, it just makes the pupil smaller and has many side effects such as headaches, blurred vision, difficulty seeing in the dark, and the dreaded detachment of your retina being obviously the most severe.  So, my personal opinion is to take all your eye vitamins and take care of yourself.  Let your body heal and maybe a couple months down the road if your eye doesn't recover, talk to the doctor about Pilo.

For any others reading, a friend of mine had HIS eye struck with a hockey stick in a game about a month ago.  He had a partial hyphema and an orbital blowout.  He had a slight mydriasis afterward, but his pupil still reacts to light and is only a bit bigger than his uninjured eye, nothing near as bad as mine.  His has improved over just the last month and he's almost back to normal.  Our bodies heal themselves when we take care of them, so don't forget to do that if you find yourself in this situation.  
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Avatar universal
thankyou so waterwings for telling me there is hope, i have a good feeling it is going to heal im just being positive..its only been two weeks and its already improving i hope you and your friend both get better!
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Avatar universal
when i had gone to the doctors last week, my doctor said that i had a very small tear in my retina, right away he did a laser surgey to patch it up and since then i barely have floaters..will this by any chance help heal my dilated pupil? also he said that the eye pressure was perfect, great reaction to light and everything else was good, he said about 6 months for it to fully heal i really hope my pupil goes back to normal size esp. i have green eyes so to me i notice it way more, if i have all good signs, is there a good chance i just need more healing time considering its only been about 4 weeks since the incident?

i really appreciate any help or answers i can get from everyone! thanks alot
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1 Comments
Avatar universal
Yeah Nik, I'd listen to your doctor.  I've heard of surgery to re-attach the retina sometimes causing pupil damage, but it sounds like you're fine.  Give the eye time to heal.  It sounds like it will.
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Avatar universal
Hey Waterwings, I have also had a dilated pupil for coming up to 10 weeks now after blunt trauma from being hit in the eye in indoor cricket by the ball.. I am hopeful of it resolving but was wondering if you have experienced much glare/ photophobia as a result and what I could possibly do to aid this?
Cheers
GP 77
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Avatar universal
Glare and photophobia, I can only assume, come from your increased pupil size, allowing in more light.  As my Pilocarpine wears off and I go outside, any colors that reflect light are difficult to look at and VERY bright.  White cars are the worst.  For me, since I wear glasses, I squint to combat it.  If you don't have corrective lenses on, the only way to combat it, without medical intervention, is sunglasses.  You're still only 10 weeks in so eat healthy and be hopeful, things could come around.  

As an update to my own case, we've been trying for awhile to find a prescription that works best for my injured eye, as the Pilo is causing my prescription needs to change throughout the day.  Just letting individuals know, if you are on Pilocarpine and need corrective lenses, the Pilo may be affecting your range of accomodation and causing problems trying to get a reliable lense.  As an example, when I put my drop in, I am pretty blurry for about the first 1.5 hours.  Midway through the medicine and when my pupil is wide open, I see pretty well.  Anyway, just a word for anyone wondering, the Pilo does cause more unexpected issues for those with higher levels of astigmatism that need corrective lenses.
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Avatar universal
Thanks a lot for that encouragement and advice waterwings, I think this is one of those situations in life where its best to try and adjust to it and make the most of each day but at the same time hold out hope it will be corrected!
All the best with you're situation!
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Avatar universal
Thank you for taking the time to post all this relevant information.  I am on my 8th day of trauma since being hit in the right eye with a racquetball, I've the sport twice a week for 12 years and have been side lined since the hit.  I was diagnosed with a contusion in the back of the eye and since have had traumatic mydriasis. I am a very active 34 yr old male and this so far has been a very frustrating experience.  Especially not being able to read or see the computer screen.  I am still on Atropine 3x day and Prednisolone 4x day.  After the hit I lost vision for about 4 hrs and was able to see foggy the next day.  I am trying to accept what has happened and that it can only get better....the Dr. said the pupil was "vaguely" responding when I saw him last 6 days ago and it is what he said in the ER the day of the injury.  Good luck to all of you that have this annoying condition and if and when I recover my sight I will always wear eye protection, no exceptions.  
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Avatar universal
I recently (6 days ago) was hit in the eye by a racquetball. I have been worried sick that my dilated pupil (extremly large) will be permanent due to internet research that was vague and blunt. This site containing others' situations and experiances has been the biggest uplift thus far. I have not been to a doctor as I do not have medical insurance and also suffering financially. I have been diagnosing myself purley on internet research. With all of your posts in mind, I have come to the conclusion "And I thought my eye was messed up??" I now feel I will be fine if I just stay healthy, take vitamins, and give it time. Thank you all sooo much for the advice and hope. It means more to me and Im sure to others more than you know! ( or mabye you do )
Thanks Again!!
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