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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.
Hi dapeng, sorry to hear this. Dont understand me bad, I'm also fighting against mydriasis every single day yet, its very, very bad. I just found a way to live with this and I'm sure you will find too.
Honestly, I have no hope of full recovery for me, but once pain is signed-off, I can accept it as-is and life is going on.
Did you tried a neuro-ophtalmologist ? Sometimes I think that only an ophtalmo is not enough due to the limited experience with "not common things" like mydriasis, most of them (at least those I saw) are used to work with prescription glasses and related issues.
As Dr. John told, seems that in your case you are facing a kind of Glaucoma, did you tried some drop to handle this ?
Honestly, I have no hope of full recovery for me, but once pain is signed-off, I can accept it as-is and life is going on.
Did you tried a neuro-ophtalmologist ? Sometimes I think that only an ophtalmo is not enough due to the limited experience with "not common things" like mydriasis, most of them (at least those I saw) are used to work with prescription glasses and related issues.
As Dr. John told, seems that in your case you are facing a kind of Glaucoma, did you tried some drop to handle this ?
Hi, robsonvf,
congrats on your progress. I am really glad that you are on a good way of recovery. I hope you all the best.
I am still struggling with the mydriasis everyday, since it just won't get better. My pupil is about 6.6mm and there has been hardly any improvement in last months. The pupil is showing very small reaction to light, but it is very limited. The good eye has now a very small pupil (1.6mm). The pressure is also instable. The most frustrated thing is, that no one can tell me exactly, what is happening within my eyes.
I am trying to get Alphagen-P (must be imported, since it is not available in Germany) and also waiting for my iris print lens. I desperately would like to do things I used to do. But currently I am just not able to.
regards
Dapeng
congrats on your progress. I am really glad that you are on a good way of recovery. I hope you all the best.
I am still struggling with the mydriasis everyday, since it just won't get better. My pupil is about 6.6mm and there has been hardly any improvement in last months. The pupil is showing very small reaction to light, but it is very limited. The good eye has now a very small pupil (1.6mm). The pressure is also instable. The most frustrated thing is, that no one can tell me exactly, what is happening within my eyes.
I am trying to get Alphagen-P (must be imported, since it is not available in Germany) and also waiting for my iris print lens. I desperately would like to do things I used to do. But currently I am just not able to.
regards
Dapeng
Hi John, I´m think that make sense it be *also* related to some cervical issue, I'll see a doctor to check this.
For readers, I'm now 4 months and a week since Mydriasis and life is really better than the first months. I think that due to this issue I got some worry about to "never more do things I used to" and then, I'm doing this much more often, lol.
Last days I've noticed an interesting improvement on pupil size (despite MDs told me that I have no tears on my pupil, I can notice an abnormal iris margin, what my own diagnostic suggests one or two tears which blocks the full-function (currently, partial function)) - I´m not sure whether this improvement is due to heavy-sun light (summer here in Brazil) or healing, but I think my pupil is now (under normal conditions) around 5mm (a month ago it was 7mm), while on sunny days it is 3mm.
for those who are using or would like to use Alphagan-P, I've noticed that it works better if you drop it in your injuried eye and go outside for several minutes, last weekend I did it and the effect and duration was really good: pupil down for 5+ hours in a "small size" 3~4mm.
For readers, I'm now 4 months and a week since Mydriasis and life is really better than the first months. I think that due to this issue I got some worry about to "never more do things I used to" and then, I'm doing this much more often, lol.
Last days I've noticed an interesting improvement on pupil size (despite MDs told me that I have no tears on my pupil, I can notice an abnormal iris margin, what my own diagnostic suggests one or two tears which blocks the full-function (currently, partial function)) - I´m not sure whether this improvement is due to heavy-sun light (summer here in Brazil) or healing, but I think my pupil is now (under normal conditions) around 5mm (a month ago it was 7mm), while on sunny days it is 3mm.
for those who are using or would like to use Alphagan-P, I've noticed that it works better if you drop it in your injuried eye and go outside for several minutes, last weekend I did it and the effect and duration was really good: pupil down for 5+ hours in a "small size" 3~4mm.
generally "adherence" (scars called synechae) scar the pupil shut not open. They are easily seen by the Eye MD with the biomicroscope (slit lamp). JCH MD
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