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.

[tobyjbrown]

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.

[tobyjbrown]

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!

[Waterwings]

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.  

[Waterwings]

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.

[mydriasis]

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.

[Waterwings]

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!