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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
Hey there and I'm glad you were able to get gain some hope from this thread.  Keep an eye out for flashes of light or what looks like a shade falling over your eye.  These are signs of a detached retina and if they show up, see a retina doctor IMMEDIATELY.  They can normally fix it if caught in time.  I think you're at most risk for this in your first month after the incident.  Otherwise, if you didn't have a hyphema, (and though there's never a substitute for proper medical care), I would expect your doctor to just tell you to give it plenty of rest.  
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Avatar universal
I am also a case of dilated pupil and here is my story:

This happened about 6 months back when I my pupils appeared to be of different sizes when I saw in the mirror. I ignored the situation thinking that maybe light was falling unevenly in both the eyes and also, since, I was also undergoing treatment for convergence insufficiency (CI), thought it might be related it to the CI problem. When I mentioned the situation to the doctor conducting the eye exercises for treating CI, he was quite alarmed, as it was not there before.

I checked on Internet and found that dilated pupil can be caused by trauma, multiple sclerosis, tumor or some brain injury.

Other reasons could be drug abuse, certain medication or eye drops and in these cases the dilation should be temporary.

The dilated pupil affects the near range vision like reading a book, working on computer, etc. as looking at close distance requires pupils to constrict. Since, dilation allows extra light to enter into the eyes, it also causes problems in bright light situations (photophobia) like going out in a sunny day.

My pupil on one eye dilated due to simple eye trauma involving hand hitting the eye. Since, I could not remember the event, the following sequence of events ensued to do initial tests and rule out other serious possibilities.

1. Field Test - I think this tests the range of my sight at different angles.
2. VEP  (Visually Evoked Potential) – I think this was to check the response time of my optical nerve, which sends the light signal to the brain.
3. MRI (Magnetic Resonance Imaging) – I think this was to rule out the possibility of tumor in the eye region. To be doubly sure, contrast test was also done, by injecting me during the test.
4.  Next step was to see a neurologist who too could not find any problem.

As all the reports were perfectly fine and as the cause of the problem could not be located, doctor suggested to wait and watch and visit him again after a couple of months.

Recently, I happened to recollect the incident involving eye trauma and went back to the doctor with this new information and he immediately concluded that it is a case of traumatic mydriasis. The doctor recommended an OCT (sonography for the eye), to rule out any other injury within the eye and this test did not show any other problem.

So, now, no other problem has been found other than the fact that my pupil is dilated due to eye trauma which has weakened the muscles (iris) that controls the pupil, the doctor has prescribed me Pilocar 2% which reduces the size of the pupil to a small dot (can be referred to as miosis) but comes back gradually to its earlier dilated state in lets say 15-20 hours time.

Currently, I am not clear if Pilocarpine drops helps to heal or it is for temporary relief. If, it is just for temporary relief, then I would rather not use the medicine as I have got corrective lens to fix the short range problem and use sunglasses when out in the sun.  I was recommended progressive lens but currently using single vision. But that’s another story.

Although, the doctor has not given me much hope of recovery, reading posts here has given me some.

Please note that the above information is provided for the benefit of others and accurate as per my knowledge and understanding.
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Avatar universal
Thanks for adding to the thread, eyehope.  Very informative post.  Yours doesn't seem to be that bad, so let's hope for your recovery.  I would strongly recommend trying lower doses of Pilocarpine.  Given the possibility of the detached retina, I'm just a believer to use as low a dose as is effective.  I was using 1/8 of a percent solution that I had to mix myself that my doctor showed me how to.  Of course every person's iris reacts differently to pilo so you may need a stronger dose, but still I'd recommend trying it.  You'll notice when your pupil gets real small with the 2% dose, your distance vision is poor and the shades of colors will be affected as to what the eye sees, since it's letting in minimal light.  You'll also notice your field of vision may seem smaller, as I felt claustrophobic when I used mine, and could even see my nose using the drops.  Just food for thought, you may want to try a more diluted dose of pilo to achieve more normalcy to the size of your pupil, and be safer as well.
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Avatar universal
HI There Guys I had an accident about a month ago with a bungy chord it sprung back and hit my right eye. I did not have time to close it and had a traumatic micro hyphema and a traumatic mydriasis.  Two doctors said the same thing and confirmed that I was one of the lucky ones who had escaped blindness. I thank God I did not get any damage to my retina and holes in my eye which is said to cause blindness. I read here on this post that some of you are taking vitamins and supplements. Please let me know what those are.  I have been off of atropine for about 3 weeks and my pupils still dialated one Doctor says effects could last up to 6 weeks so I am hopeful that my pupil will return to normal.  Please get rid of your bungee chords and tell your friends they are dangerous. Like some of the other posts I found some hope in here as my vision is very blurry and I have photophobia.  Another gentleman here in the post had a similar accident and his vision almost came back to normal this is a great thing and it gives me hope that my vision will come back on my right eye.  Thanks for the posts.

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Avatar universal
My acupuncturist prescribed I-Caps to me, that I can buy from almost any pharmacy over the counter, but I got them from Walmart.  
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Avatar universal
I was hit in the right eye by a golf ball on October 26 -- more than four weeks ago.  The ball hit a tree 5 or 6 feet in front of another player who hit the ball  and ricocheted directly into my eye.  I lost all sight for a while, my RGP contact was shattered and cut the cornia and I had lacerations on the lid and below the eye requiring 14 stiches.  After an ambulance, emergency room, I was taken to an eye clinic where they said I had a hyphema and was given Atropine and prodnolisone and told to stay quiet for 5 or 6 days and see the Opthmalogist once a day.  

My vision was very cloudy but gradually has recovered over a couple of weeks, but after being off the atropine for almost three weeks, the eye is still very dialated.  From this great thread I learned more about my condition than from anywhere else.  

I am very light sensitive and my near vision with either contacts or my multifocal glasses is not good.

So traumatic mydriasis is my problem now.  The opthamalogist said he did not think it likely that it would get better because the muscles in the iris appear to be damaged.  

I have some hope from reading this thread.  I am not going to ask for pilocarpine until I wait until the holidays, or another month to see if there is any improvement -- but none yet.

Thanks to those who posted
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