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.

[Ana1234567]

Hi John,

I have recently had a blunt injury to the eye. I went immediately to the ER as I could not see for a couple of hours after the injury. I had mild hyphema. It has now been one month since the injury, and I am still on Predeferin Forte (twice a day). My pupil reacts to light, but very slowly.Could the steroid drop be causing the pupil to react slowly to light/mydriasis?

Thank you!

[JohnHaganMD]

The problem is not that your eye iris muscles are not working it's that they are not balanced and the muscle that makes the pupil smaller is considerably weaker than than the one in the other eye and not balanced with the dilator muscle in the injured eye.

I have no idea what "glamisolo" is.  Pilo makes the pupil smaller but in younger people blurs the vision at distance. Adhesions of the iris to the lens is unlikely 1. they are usually easy to see  2. They give an irregular pupil that is teardrop shaped.

So its likely the pilo/glamisolo  caused the blurred vision

JCHMD

[JohnHaganMD]

Brighter light smaller pupil, cloudy light larger pupil

JCHMD

[dapeng]

Hi, John,

I need your advice again.

I met another ophthalmologist last week, who did at first intensiv inspections on my eye, so that my vision got blurred after the 2-hour inspection. He told me that the nerve seems to work, because shining to my injured eye cause normal or even stronger reaction on the other eye. The muscle seem to be OK as well. But he is not sure, whether iris is somehow adhered with the lense.

He gave me also a mixture of glamisolo and pilo. About 2 hours after the insepction, my pupil size is indeed reduced (I think at least 2 -3 mm). On the day after that, the pupil got a bit bigger, but it was still very comfortable for me. But 2 days later, pupil returns to the big size and my vision gets somehow more blurred.

How would you interpret that somehow my muscle is still reacting to the medicine? Do you have a clue, why my vision got blurred (is it because of the inspection, so that my eye needs a couple of day to recover from it?)

Any advice is highly appreciated.

regards
Dapeng

[dapeng]

Hi, John,

I need your advice again for following experience of mine. Last wek I was in ski vacation. The weather was good and I stayed outdoor the whole day with sun glasses. In the meantime, I started to drop Alphagan-P. My pupil gets noticeably smaller (at least 1mm) and stayed more or less small the whole week.

After returning from the vacation, where the weather is more rainy or cloudy, my pupil somehow gets bigger again, though I am still using Alphagan-P.

Do you have any idea, what could have made the difference?

regards
Dapeng

[JohnHaganMD]

Make the best of your second opinion. Seek out the best Eye MD ophthalmologist you have access to. If possible take your old records. Ask specifically about glasses, traumatic cataract and macular pathology and if a macular OCT might be of benefit.

Good luck

[BadmintonLover]

Hello Dr. John,

Thanks for your advice. Am too is thinking a second opinion and another set of check-ups and procedures. I will visit another doctor soon so that I can compare there stand on my situation. I was not able to ask where exactly the scarring is. I was hit by a shuttlecock bull's-eye then.

If there's no way out this could be remedied then I should have to accept the fact, live, and get use to it.

Thanks for your time.