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.

[0ptics]

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!

[Waterwings]

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.

[nik622]

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?

[Waterwings]

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.  

[nik622]

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!

[nik622]

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

[JohnHaganMD]

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