Traumatic Mydriasis, need help

[Waterwings]

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.

[Lifeworthliving777]

I have felt a noticeable improvement since the weekend
The eye feels a little sensitive,  and there is a weak, numb, or swollen type feeling above the eye/upper eyelid
Possible pressure and numbness It is hard to describe but still not feeling 100%
Also dealing with some depression trying to stay positive I keep reliving the experience
I am thinking it is good to go thru it while young maybe it could have happen in the future
I was so close to leaving the country,  now I have been home with parents not blaming the U.S. but I was used to a different culture overseas and coming back I was in a depressed place. I have to work on my attitude and not let things bother me . Take care of yourselves love one another protect yourself from violence ..

I am trying to grow from this  now I am not constantly reliving the experience just hoping that healing will continue past these 5 1/2 weeks

When I faced injury in the past the 6 week mark was the hardest, I believe I have already gone through the hardest now

Psychologically I miss my loved ones I've cast some aside feeling ashamed/weak

My heart hurts

[JohnHaganMD]

=

[Lifeworthliving777]

After about 5 weeks it is healing okay more or less. Just concerned with strange feelings and light pain. Almost like a TENSION in my body and the eye still feels a little weird. Head hurts as well. I heard facial fractures take 6 to 8 weeks to heal, at least the nerves

Could anyone shed some light on this

Mornings are the toughest, and mid-afternoon

Psychologically I feel a problem, like cannot focus my mind's eye, visualize, or dream of the future (although improving) can't visualize as well is there frontal lobe damage or just in my head

At some point I feel this will be more of a cosmetic issue which doesn't bother me

I having to put things in proper perspective altho difficult

[Lifeworthliving777]

5 weeks ago I was punched in the left eye.  Have small tear(s) in iris sphincter muscle. In sunlight it constricts almost to not al size. Problem is dealing with pain and strange sensations throughout face and body. Was wondering if these feelings will subside. Also experiencing post traumatic stress-like symptoms. I have been diagnosed with anxiety disorder, depression and schizophrenia. Also not the first time being attacked. I am feeling suicidal.

[Lifeworthliving777]

Nose was fractured as was bones around eye.  I was under influence of cannabis when struck by fist.

[Sara_MHModerator]

Hello, we are sorry you are going through this very difficult time.  We have contacted you privately so please check your email and inbox on your medhelp home page.  Always remember that you can call 911 if you are contemplating self harm or a suicide pretention hotline such as 1-800-273-TALK (8255).  We wish you the very best.

[JohnHaganMD]

=

[JohnHaganMD]

=

[Alice1979]

Hi Dr John,

Firstly, this website and the threads have been so useful to me after having an eye injury a couple of months ago - thank you for sharing your expertise! I have a couple of questions in addition to the ones which others have asked.

I got hit during sports about 9 weeks ago which resulted in mydriasis and a scar on the lens of my eye. Initially there wasn't much movement in the pupil & it was a bit misshapen, however over the past 9 weeks the shape has improved (it is probably as circular as the good eye now, although much larger) and in daylight/direct artificial light it constricts a lot (not as small as the good eye but not noticeably different). The pupil also constricts quite well when focusing on objects close up.

Functionally the eye seems to be okay (other than screens looking blurry), however I've got very light colored irises and would really like it if the pupils would return to normal for cosmetic reasons.

My question is why does the pupil constrict quite well with light and focusing but doesn't constrict in response to emotional stimulation (for example boredom etc). I've found people looking at my strangely when I'm talking to them - it seems my good pupil is constricting/dilating irrespective of whether there is a change in light conditions whereas the injured pupil only responds to light and intentional focusing (rather than social/emotional reasons).

I was just wondering if this is to do with the intensity of the stimulation (i.e. light provides more stimulation than emotional changes) or whether this is to do with damage to the nerves that would provide the emotional information.

I know this is a pretty involved question about something very complex and delicate so it's completely understandable if there's no clear answer! If anyone has experience of a similar thing (or people who have recovered all of the pupils functioning, including the emotional/social response) then it would be interesting to hear from you.

Thank you for your time reading this and good luck to everyone else with mydriasis (I've been taking lots of supplements and eating healthy as was recommended on here).

Thank you,

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

First of all the most important this is whether there is any permanent damage to your eye.  A "scar on the lens of the eye" would be called a traumatic cataract.  You are also at higher than normal risk of retinal detachment and traumatic glaucoma.  You need to have your eye checked by a retina specialist to be sure you do not have breaks or tears in the retina or a problem called 'retinal dialysis"    You also need an ophthalmologist to do a test called 'gonioscopy' to see if you have 'angle recession" if so you have a significant risk of traumatic glaucoma and need baseline tests such as visual field, corneal thickness and maculalr and nerve fiber layer OCT.

The young iris has small movements that are unrelated to light exposure or focus to see at near. It's called 'hippus"   Likely the injured no longer does that and that's why it looks static compared to the uninjured eye. no way to fix that.  your pupil may continue to improve. By 6 months most people are at there final result although rarely i have seen improvement for up to a year.   Doesn't sound like you will need colored contact lens or drops to help make the pupil smaller.   Don't forget the other things that should be tested.

[JihoonL]

Hello Dr. John and Everyone

May 1, 2017
I hit my eye with a baseball.

Traumatic cataracts are said to be very small (which is later said to be fine enough to age a little earlier than normal eyes)

And the traumatic pupil mydriasis, the iris has been torn off a little.

The first one or two months do not move at all, and then gradually diminish in response to light.

About five to six months later
It is fine in daylight and very bright, but it is still large in dark places.

Even after 5 to 6 months of pupil
Could it be smaller and move?


(I was originally a diopter - 8 high myopia and received vision correction four years ago)

[JohnHaganMD]

It could be at 6 months most cases are stable.  Ask your ophthalmologist about a trial of Alphagan-P which helps the pupil stay small in dim/dark light

[flbrtz]

Hi All,

I have traumatic mydriasis (1.5 months) after a football mishap and have been looking for solutions.

Would contact lenses with an occluded pupil work by reducing the amount of light entering my eyes?

Cheers,

[JohnHaganMD]

Yes if the diameter of your damaged pupil is larger than the diameter of the pupil on a color contact lens. Also ask your eye MD ophthalmologist to try Alphagan-P eye drops.  Some improvement often occurs for 6-9 months

[flbrtz]

Thanks John, I'll that note of that.

[JohnHaganMD]

Best of luck and remember to protect both eyes from another injury