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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.
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.
By the way thank you for your response.
Actually, headache is absent and I believe the size of my pupil already gone back to normal size (if it's really) comparing it to the other. So far I can manage with any light situation. Sometimes when I am outside and the sun's at its peak it will cause me to feel uncomfortable. My main problem now is the distorted vision on that part of my eye plus the floaters are disgusting.
I am really thinking I need the glasses but the Oph did not suggest. There were times when I could no longer hold the discomfort, I have to put my hand sideways between my eyes to form a division. I'm in medication no more this time. It's like, the doctor's concluded that i have to live this way and get use to it since no more hope to eliminate the scarring on the injured part.
Actually, headache is absent and I believe the size of my pupil already gone back to normal size (if it's really) comparing it to the other. So far I can manage with any light situation. Sometimes when I am outside and the sun's at its peak it will cause me to feel uncomfortable. My main problem now is the distorted vision on that part of my eye plus the floaters are disgusting.
I am really thinking I need the glasses but the Oph did not suggest. There were times when I could no longer hold the discomfort, I have to put my hand sideways between my eyes to form a division. I'm in medication no more this time. It's like, the doctor's concluded that i have to live this way and get use to it since no more hope to eliminate the scarring on the injured part.
In reading your post I am uncertain if the problem is due to your pupil still being dilated. If so some of the recent posts including robsonvf might be helpful. I cannot determine also where the scars are. Usually in traumatic mydriasis there are no visible scars. You symptoms suggest you might have a small scar in the macula.
I might suggest a second opinion, trial of glasses, amsler grid testing and perhaps macular OCT.
JCH MD
I might suggest a second opinion, trial of glasses, amsler grid testing and perhaps macular OCT.
JCH MD
Hi @badmintonlover, while you are waiting for Dr John response, I can offer my own experience on it once I have the same symptoms as you.
For me, since mydriasis, my issues are: worse near vision and headache. I fixed near vision only with glasses and see, I tried lots of things such as pilocarpine (so much disconfort, despite works), alphagan-p (small improvement) and glasses to fix the focus on the injuried eye: this worked. Today I can work only with glasses (I work with computers), without it, I think that is impossible.
Doctors, usually, dont know how is to live with this problem, for the most part of them (mainly those whom have no experience with traumatic mydriasis) just think that your pupil is greater and there is no other real problem.
I 've fixed my headache using a drug called "Indocid", very, very useful.
so, IMHO, glasses are TOO MUCH important in our situation.
question:
do you have headache due to your mydriasis ? how to handle this?
what is your pupil size, does it respond to light?
thank you!
For me, since mydriasis, my issues are: worse near vision and headache. I fixed near vision only with glasses and see, I tried lots of things such as pilocarpine (so much disconfort, despite works), alphagan-p (small improvement) and glasses to fix the focus on the injuried eye: this worked. Today I can work only with glasses (I work with computers), without it, I think that is impossible.
Doctors, usually, dont know how is to live with this problem, for the most part of them (mainly those whom have no experience with traumatic mydriasis) just think that your pupil is greater and there is no other real problem.
I 've fixed my headache using a drug called "Indocid", very, very useful.
so, IMHO, glasses are TOO MUCH important in our situation.
question:
do you have headache due to your mydriasis ? how to handle this?
what is your pupil size, does it respond to light?
thank you!
I am sorry for the error in the fifth par. The vision of uninjured eye looks nearer compared to the injured one.
Hello Dr. John,
I was not able to read all the recent comments of this thread but I was posting here 3 years ago during the time of my injury.
It's been 3 years since the injury and I believe that the damage of my eye would be forever. I have completed the medication but wasn't in regular visit to the doctor until recently.
I have my eye checked today and the Ophthalmologist said that the injured part had scarred and there is no way to treat it just like the scar we could have anywhere in the body.
My only complain was that when I have to look at the objects particularly words, the images in the part of the injured eye was like there's a glass in it and when I focus to smaller letter, it was covered by somewhat a white spot from my eye. There were also floaters which I am used to since the day of my injury.
According to the doctor, my eyes have no other defects. I even asked if I need glasses because I feel like I need one and he said "not at all" because when I covered one of my eye, the injured one looks nearer compared to the injured one.
This is really a total hassle but I teach myself to get use of it because if it's true that there's no way the scar be removed, then I would have it my lifetime. A fate.
I appreciate your comments in my situation and thank you very much for that.
I was not able to read all the recent comments of this thread but I was posting here 3 years ago during the time of my injury.
It's been 3 years since the injury and I believe that the damage of my eye would be forever. I have completed the medication but wasn't in regular visit to the doctor until recently.
I have my eye checked today and the Ophthalmologist said that the injured part had scarred and there is no way to treat it just like the scar we could have anywhere in the body.
My only complain was that when I have to look at the objects particularly words, the images in the part of the injured eye was like there's a glass in it and when I focus to smaller letter, it was covered by somewhat a white spot from my eye. There were also floaters which I am used to since the day of my injury.
According to the doctor, my eyes have no other defects. I even asked if I need glasses because I feel like I need one and he said "not at all" because when I covered one of my eye, the injured one looks nearer compared to the injured one.
This is really a total hassle but I teach myself to get use of it because if it's true that there's no way the scar be removed, then I would have it my lifetime. A fate.
I appreciate your comments in my situation and thank you very much for that.
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