Sorry I neither understand you description of the problem nor have I seen anything like it.
JCH MD
My wife had a neurosurgical intervention six months ago for a congenital arteriovenous malformation of the left temporal lobe. After surgery, she permanently blinded in his left eye (apparently due to embolization prior to surgery, central retinal artery was damaged). Right eye seems to be intact morpho-functional (as said ophthalmologist). The pupil reacts normally to sunlight during the day: miosis, mydriasis operating normally, according to the intensity of light. But any type of artificial light (incandescent bulb, fluorescent light), regardless of the intensity of this light, the pupil reacts with high mydriasis, which remain so as long as artificial light source persists. I said that although his left eye is blind, he reacts synchronously with good eye.
What kind of damage could cause such symptoms? There are treatment solutions?
Hoping that I can have your opinion, I thank you.
Horia Dascal, in Romania
In a situation like this one would expect an "afferent pupil defect" which you are likely aware of that is if light goes in the Good eye it constricts and so does the bad eye but when the light is focused on the bad eye both eyes dilate. Testing them quickly is called a swinging flashlight (torch for you in the UK) test.
I do not know how a lesion could cause your wife's symptoms. If the neurologist and neuro-ophthalmologist don't know then it may be the first of its kind and her physicians should consider writing the case up and putting it in a medical jorunal
JCHMD
Dear Doctor,
Thank you for your answer. I mention again that my wife left eye is completely and irreversible blind (confirmed by an ophthalmologist). In this situation, the right eye reacts normal to natural light, but paradoxically reacts to artificial light, with mydriasis. Ophthalmologist said right eye is OK, but does not know what is "behind him"; neurosurgeon sent me to ophthalmologist, ophthalmologist sent me to the neurologist and neurosurgeon, and I do not know what I can do to help my wife . It is a mydriasis occurs only artificial light, and it strongly affects quality of life for my wife. What do you advise me in this situation?
Horia Dascal, in Romania
It is an unusual mydriasys, because fotomotor reflex is normal in natural light. I say that mydriasis is also in good eye and, therefore, my wife feels blinded by artificial light. I specifically you, again, as abnormal mydriasis occurs only artificial light (light bulbs, fluorescent light, TV or computer screen). Basically, because mydriasis get as much light in the good eye, that vision is very blurred, she has vertigo and vomiting, so, consequently, she becomes unable to do any work. The greatest problem remains the artificial light. Being blinded incessantly, my wife fails to have any activity. Even television, which could have occupied her time, it blinds her incessantly. The computer does not enter into discussion, because she can not even watch the monitor screen.
Pilocarpine in Romania can not be purchased in pharmacies, an ophthalmologist has given us to use a vial of 3% pilocarpine, expired a few years. We have doubts as to use.
Doctor, do you think there may be partial lesions of visual area responsible for receiving a specific wavelength of light (the artificial)?
Many thanks, Horia Dascal, from Romania
Pilocarpine is extremely inexpensive in the West, perhaps you can order some on the internet. 3% is rather strong, especially if you wife if younger than 50. 1% pilocarpine would be a better place to start. You could also order 2% and have a pharmacist dilute it in half with sterile normal saline. That would give you 1% and 2% to try.
I have no idea why she has this problem. Finding out why she has it is not as important as giving her some relieve. That might include wearing hats with brims, photochromic glasses, tineted glasses, sun glasses, wrap-around sun goggles that have side and top shaded areas.
JHaganMD
You could try a weak solution of pilocarpine in the right eye. You could also try Alphagan P which inhibits dilation in dim light.
JCH MD