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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.
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Avatar universal
after a long time... I'm here to provide some hope to those who're recently facing this injury... after almost two years since my injury, it was improving time after time till the current state which is: I don't need glasses nor drops anymore. Sunglasses are optional now. and the vision is about 99% better. Sometimes seems it's better than before. I'd say that I'm 99.9% recovered. Regarding the pupil.. well, it's still bigger than the other one but is impossible to note the difference without pay a really attention over it.

Keep your hope. This terrible injury will improve with time.
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1 Comments
Thanks for the follow up. PROTECT YOUR EYES FROM ANOTHER INJURY. Just saying.
Avatar universal
Hi Dr Hagan & Everyone,

I was hit in the eye 2 weeks ago and since then I have traumatic mydriasis. The pupil reacts to light and I feel it's a little better than a week ago, it's around 4 mm.

In the last visit to the doctor he told me he saw a little tear in the sphincter.

Is there still a chance that the pupil will go back tot normal even with the small tear in the sphincter?

Another problem I have is the blurred vision. I saw that reading glasses can help while working with computers, is there something that can help long distance focus?
Do you recommened the use of glasses for focusing?

Ben
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1 Comments
First be sure you are under the care of an Eye MD ophthalmologist. Injuries such as these can be associated with problems elsewhere such as retina tears, retinal detachments, inflammation, glaucoma and traumatic cataracts.  Usually this is treated with steroid drops for the common association of traumatic iritis. Also if you are using a red topped bottle that dilates and rests the pupil and will keep the pupil bigger than after you stop it.  Sometimes the pupil returns to normal sometimes not. No way to tell yet.  Since your other eye was not injured most people do not need to use reading glasses.  Distance glasses are prescription and too early to see if you need one.
Avatar universal
Dr Hagan, is it possible for an aphakic to develop pco or capsule opacification? Reason I ask is I am trying to pinpoint my glare issues and slightly hazy vision to pco or traumatic mydriasis. Thanks
Helpful - 0
3 Comments
Yes it is possible if the posterior capsule was left in the eye or if a problem called Soemmering's Ring develops
thank you Dr Hagen, i have read online that younger patients are more suspect to pco? Is 34 considered "young enough" for pco 5 months into being aphakic ? can this easily be diagnosed or are special tests needed?
Yes at 34 PCO often develop quickly. Easy Dx with dilated pupil and biomicroscope (slit lamp exam)
177275 tn?1511755244
=
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Avatar universal
yep, it´s a little red. Okay then, thank you! ;-)
Helpful - 0
177275 tn?1511755244
Redness is not a consistent part of dilated pupil syndrome. Since its only a little red I would suggest not doing anything except perhaps using an artificial tear. Whitening eye drops like Visine and Murine are not good for long term repeated use.
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