Dilated Eyes

[jasonleon]

I had my eyes dilated again a few days ago for an evaluation (Tuesday) it's currently Saturday and my eyes still feel like it isn't normal. During the initial day my eyes were itchy and blurrier than before with pain. Yesterday my eyes started to become watery and tears came out of no where. The itchiness and pain are a bit gone today but still my eye vision feels worse than before. I remember that they didn't give me any sunglasses on the day of the dilation. What could it possibly be? Should I make a visit to the ER?

[JohnHaganMD]

Dry eyes wax and wane but generally gets worse over time. I've been on Restasis for several years.

[jasonleon]

Dr. Hagan,

I've been getting floaters for a week or so now, everytime I'm watching T.V in the dark and go to the bathroom with the lights on. I see a black dot in front of my eye that is falling. When I return back to the room and watch T.V again it appears and disappears. I've never had floaters in my life before. Could the dilation or the allergy eye drops be causing this? Or it could be a sign of sudden retina detachment?

[JohnHaganMD]

There is a long discussion thread here in which a group of people state dilating their eyes caused floaters. This is of course false and the relationship is incidental not causative. Dilation is used for many conditions in which floaters appear or appear in greater numbers such as PVD, flashes, complaints of floaters, routine eye exams.  Floaters become more common as we age. By age 50 half of us have floaters.  Only a very tiny number of floaters are due to RD or retinal tear or hemorrhage. These usually have flashes of light like lightening, loss of peripheral vision and floaters occur in showers of hundreds of small black soot like particles. Neverthess if a new floater would suggest your discuss with your eye doctor.  

[jasonleon]

No new ant-histamines as far as I know. If I move back to where I resided prior to moving here, is there a chance of my dry eyes being cured or is it a chronic condition that I must control via eye drops for a lifetime? Looking forward to your advice.

[JohnHaganMD]

The possibilities:  1. You're 2 years older  2. You have come into contact with a different set of allergens or environmental stressors  3. You're on new medications (e.g. anti-histamines) that dry the eye.

[jasonleon]

Dr. Hagan, you were right regarding the dry eyes. I went back for an evaluation today and they said it was caused from the dry eyes and it was from allergies (environmental) and not from the dilation itself. I was prescribed some Olopatadine drops for the allergy and some additional lubricant tear drops. It is interesting because ever since I moved to Kentucky in the last 2 years I developed dry eyes, and I never had it before in my life..so I am curious to what may have caused it.

[JohnHaganMD]

Tropicamide comes in 1% and 0.5%  I suspect the problem is not the drop but that post exam you did not blink enough, did not use artificial tears enough or touched your eye with a tissue.  For people with dry eyes or a history like yours we 1. urge them to blink often during office visit. 2. Examine the cornea before they leave office  3. Instill artificial tears at office.  4. Give a sample of artificial tears and ask they put set in when get home and every 30 minutes for 3-4 hours.

[JohnHaganMD]

Theoretically dilation can cause acute angle closure glaucoma but its rare especially in young people and the symptoms are dramatic: intense pain, nausea, vomiting, fixed dilated pupil, cloudy cornea and ultra high pressure. Doubt you had that. Find out what was used to dilate and try and avoid next time.

[jasonleon]

The name of the dilation drops they used are called tropicamide. When I asked what dosage, they said there wasn't a specific dosage just that they used a "drop"..

[jasonleon]

I also found out the drops they used at my first clinic in which I had no side effects and they told me Tropicamide 1% and Phenylephrine 2.5%. If they had both used tropicamide I am curious to why I had developed a reaction this time and was fine at my first clinic. I used the same amount of tear drops after both evaluations.

[jasonleon]

Thank you for the reply. I went to the ER last night where they did a evaluation with a special light that checked for scarring in the cornea everything was negative and they told me it might have to been an allergic reaction to the dilation (I was not given anything from the ER), I was told to follow up with an opthamologist for further testing. I forgot to mention in my initial post that my eyes felt blurrier and the vision seemed to have gotten worse. I did ask the ER doctor if it might have been some sort of glaucoma attack but he told me he didn't think so because he didn't see any cloudiness. Do you think this was an accurate diagnosis and that the chances of a specific glaucoma attack was not the case? I was a bit skeptical and am worried as they don't have all the evaluation equipment in the ER. (As I did read that dilated pupils could trigger them).

[JohnHaganMD]

This is a common problem especially in people with dry eyes (most older than 40).  You can try getting artificial tears and using hourly today with some cool or warm compresses (whichever feels better). Call your ophthalmologist or optometrist tomorrow and tell him/her what happened. Ask to come in for an exam. (usually these are done without charge).  Ask them to note on your chart. In the future perhaps milder drops might be used. After the exam in the future blink frequently, use artificial tears every 30 minutes for 4 hours after your next exam and be careful not to blot your eyes with a tissue with your eyes open. Not have "dark glasses" did not cause this its almost always dry eyes due to intrinsic dryness and the drops also slow blinking and promote corneal drying.