Treatment for dilated pupil (traumatic mydriasis)

Hi there,

Just wondering if you know of any potential treatments available to someone suffering from mild traumatic mydriasis in one eye. I was struck in the left eye with a tennis ball about 3 years ago, leaving me with one pupil slightly larger than the other, and photophobia in the affected eye. I have been to see one optometrist and two opthalmologists since then, who have not been able to offer any treatment for my condition.

I have been doing some of my own research on the internet and I noticed that in some cases, pilocarpine hydrochloride eye drops have been administered to patients suffering from mydriasis, but I was alarmed to read of some of the potential side-effects including retinal detachment. Have you ever prescribed this drug to anyone suffering from my condition, and do you think it could be used as a long-term solution in managing an excessively dilated pupil, or even "train" my iris sphincter muscle to regain some of its lost function?

Also, I read that the surgical procedure cerclage pupilloplasty can be used to correct traumatic mydriasis. However I was alarmed to read that once the cerclage is in place, the pupil can no longer dilate reactively (my affected pupil can still change size reactively, it is just consistently too big by a millimetre or two in diameter from observation in a mirror). Do you think a cerclage could be spring-loaded to allow the pupil to retain reactive function to varying light intensity?

If you could think of any other potential treatments for my condition, I would also be very appreciative.

Thanks, David.

[Forum-OD-MP]

pilo might work for you, but you're right it does have some pretty alarming possible side effects.  i just spoke to a patient ont he phone last week who is suing his ophthalmologist for Rx'ing pilo and causing a retinal detachment.

you'll have to find someone who's not scared of Rx'ing it if you want to try it.

no, it will not "train" your iris to do anything.  the instant you stp using it, assumedly you'll be back to how you are now.  

one of the problems with pilo is that you cant control how much miosis (pupil constriction) you get.  if you start pilo in your affected eye, the likely scenario is that the medicated eye will then have a MUCH SMALLER pupil than your normal eye.  so there goes your cosmesis.  it would probably help with the photophobia, tho.

"Do you think a cerclage could be spring-loaded to allow the pupil to retain reactive function to varying light intensity?"

NO.  it cannot.  you'd be totally "stuck" with one, un-variable pupil size.

cant think of any other treatments...sorry.

[mild_traumatic_mydriasis_sufferer_2003]

Thanks for your help. It seems like there isn't much hope for a fix in the short term, although my opthalmologist did say that my symptoms should resolve with time on my last visit. However the condition of my affected eye is still debilitating more than 3 years after the initial trauma, so if anyone else out there has this condition and has heard of possible treatments (or at least a "safe" drug that can be used to manage this condition) I'd love to hear about it.

Cheers,
David

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