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.

[robsonvf]

Dapeng, are you facing some pain in your neck, kind of stiff neck ? This is the only pain that still persists since Mydriasis... I think that due to my focus issue my head/concentration position is changed what may be the cause.

What are your main problems dealing with that (besides photophobia and near vision) and what you do to combat it ?

[JohnHaganMD]

=

[dapeng]

Hi, John,

thanks a lot again.

regards
Dapeng

[JohnHaganMD]

You would have to wear a bifocal contact lens on the eye with the problem. The top of the lens for distance would presumably be zero and their would be a reading add that the fitter would probably be a littler stronger than the reading glasses you find helpful.

[dapeng]

Hi John,
thanks a lot your great suggestion.

I am still curious to know whether there is a solution for the contact lens problem. I do really want to try an contact lens with print.

Does it make sense to take just a plain contact lens without diopter, but with a print, so that I am less photophobia. If necessary, I can wear an additional reading glass.

Thanks in advance.
Dapeng Wang

[JohnHaganMD]

At your age you would expect the contact lens to blur your distance vision just like the reading glasses do. The reading glasses have a focal point that is clear. Anything further away will be blurred.

I don't know why your eye would be more photophobic unless your cornea was drying.  When you do your near work (read, computer) every 10-15 minutes take the glasses off, focus far away (down the hall or out a window) and blink forcefully 4-5 times. It does two things: Stretch your focus muscle (ciliary body) and moisten your cornea.

JCH MD