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Dilated Pupil after Retinal Detachment

My husband had laser surgery for a partially detached retina about 10 weeks ago. His pupil has remained dilated since then. He is following up closely with a retina specialist but I am frustrated because the doctor just says "I don't know" in response to our questions about whether the pupil will heal.

Last week my husband had a sneezing fit and his pupil slowly constricted right after the sneezing fit. It immediately dilated again but we were hopeful that the pupil was finally showing signs of healing. Can anybody give me feedback on this? Could this be a sign his pupil is getting better or could it mean nothing at all as my husband's doctor seems to think?

I believe the pupil is slightly less dilated than it was right after the surgery but my husband feels the slight improvement is not significant enough. If the pupil is improving, would we expect very gradual changes over a long period of time?

The other night when we went out to dinner we both noticed a significant decrease in the size of his pupil but it lasted only for a short time. Again, we don't know whether this is a sign his pupil might be starting to get better.

My husband has been very depressed and not himself for two months now. I don't want him to lose hope.
Best Answer
233488 tn?1310693103
MEDICAL PROFESSIONAL
If the RD came from trauma the pupil could be dilated due to "traumatic mydriasis or traumatic iridoplegia"     It could be due to drops used to dilate the pupil and rest the eye after surgery. These are generally in a red top and atropine is the strongest. They can take weeks to months to wear off. The pupil could be dilated due to the RD surgery as a not infrequent complication due to having to buckle the eye or freeze over a nerve to seal the holes.

If the pupil got small after sneezing its a good sign and means the pupil is not completely paralyzed.  The surgeon is being truthful with you and only time (maybe 4-6 months) will tell if the pupil will improve. You can use the search feature and archives to read about this problem. Several questions regarding same problem in last few weeks.

JCH MD
7 Comments
Thank you for this info Dr John. I am very nervous, I had a single tear vitrectomy for retinal detachment and was put on the Atropine Drops for nines days post surgery, it is my 13 day off them and my eye is still dilated. Yesterday, my Doctor told me via phone she is not concerned and that these drops could keep me this way for awhile. How would someone know if the eye is going to be permanently dilated. Could a second opinion doctor examine me and tell is this is the case. Thanks Tom
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My reply did not go through.  A second opinion would not be able to tell you anything, only time will. If you have blue/gray/green eye atropine may take 3 weeks to wear off, sooner brown eye. The pupil can be permanently dilated not by atropine but my trauma or surgery, especially if you had scleral buckle.   Generally whatever the pupil is at 4-6 months post surgery is permanent.
Thank you Doctor Hagen, I have a green eye and its been exactly two weeks to the day.  I was on the drop for nine days, twice a day. I did have a Vitrectomy and not a Buckle. today, my doctor said she is 100 percent sure that there was no surgical issues from the surgery. So your comment brings me some feelings of ease.
Your changes are good.  Atropine often lasts 2-3 weeks. So Likely you are okay. Remember when you have spontaneous tear or RD in one eye changes in other eye are extremely high. 1-10% depending on a number of factors so have annual dilated exam by Eye MD and report new floaters, flashes, loss of field of vision to your retina surgeon immediately.
Two last questions, I promise.

1. Should the dilation persist after next week should I go to a Nero Op?
2. I have been taking Xanax to relieve stress and help me sleep, could this affect the eye?
Thank you again
1. seeing a neuro-op would be a waste of time and money.   If your pupil returns to normal size over the next 4-8 weeks no problem. If it doesn't then it is related to your surgery and not a diagnostic problem.
2. No
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233488 tn?1310693103
MEDICAL PROFESSIONAL
Best of luck.
JCH MD
Helpful - 0
1 Comments
Avatar universal
Thank you very much. I appreciate your feedback very much. The first physician told us in most cases the dilated pupil will resolve after several months and the second physician just gives practically no feedback. The impression I've gotten from the second physician is that the dilated pupil is extremely rare but the feedback from this forum (and the first physician) is that this is not uncommon.

My husband has been convinced the first physician caused this damage and I have wanted to give him the benefit of the doubt. As you said, It's not a good feeling to second guess how things "could have been".

Thank you.
Helpful - 0
2 Comments
Lisa, can I ask how your husbands pupil is doing now, four years later?
I too would like to know if there was any improvement. I am currently suffering the same situation post Op.
233488 tn?1310693103
MEDICAL PROFESSIONAL
I've spend much of my career giving second opinions. It's always easy to be critical of the previous physician's care. However this is always in hindsight and the original circumstances are not known. Lasering the retina and hitting a nerve (that can't be seen) is often unavoidable and does not mean the original MD used too much laser. I have treated patients for retinal tears and had one or two with slight permanet dilation of the pupil.  I add this because its important to avoid feeling that if only a little less laser was used it might not happened. Any less laser and the retina could have entirely detached.

JCH MD
Helpful - 0
Avatar universal
My husband didn't receive the long acting drops to dilate his pupil. He went to another specialist because he wasn't happy with the doctor who performed the laser surgery. The new retina specialist says that either the optic nerve could have been damaged or the nerves that control the function of the pupil were damaged. He does not know and does not know if/when there would be improvement.

I'm glad to hear that the pupil getting small after sneezing is a good sign because my husband's doctor did not know anything about that and said he had never heard of that. He says the original doctor did more laser than he would have done and that the laser has caused the damage to his pupil.

Thank you. You have given more feedback than my husband's doctor did.
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