Eye dilation drops during eye exam

My dilation drops at my last eye exam with a Cataract Specialist caused my throat to collapse during sleeping that evening.  I woke up several times gasping for air and had to drink water and relax to open it back up.  Really scared me.

Do any of the Doctors on this forum know about this reaction ?  The technician used two different dilation drops, she said one for each eye muscle.  They also did numbing drop to test pressure and then the Cataract specialist put another eye drop in when he got me into his exam room, right before another Cataract eye test.  Right after he grabbed me to insert the additional drop, I said "his tech already numbed and dilated me", but he continued to insert the drop anyways.

Is that NORMAL procedure, or did he put in one too many drops ?  My eye was completely dilated very wide before I got to him and it was within 20 minutes of when the Tech dilated me.
On the chart notes it shows N 2.5 and M 0.5 next to the dilation area.

(The technician did the IOL Master as well as a couple other machine tests before I even saw the Cataract Specialist)
Any information on this would be very helpful.
Thank you in advance !

[John C Hagan III, MD, FACS, FAAO]

N stands for 2.5% neosynephrine and M 1% is mydryacil:   Neither one of them should have caused that reeaction; Any reactions to the medications (and your's is not typical at all) is usually immediate within the first 15-20 minutes of installation.  

As a delayed reaction they should not cause that especially that late. there were 3.25 million cataract operations in USA in 2010 and your's is likely one in a million.  No excess drops run over the lid and down the face. I would discuss it with your surgeon and the anesthetist/anesthsiologist to look further for a causes.

JCH MD

[Luvtoski]

Thank you Dr. Hagan for your detailed response.  I called and found out the "extra" drop the Cataract Dr. put in before a "blue light pressure test".  (I never had this type of pressure test, always had the Tonopin)

The extra drop he used was "Fluorescein Sodium & Benoxinate Hydrocholoride 1/4% / .4%.  A yellow dye drop to due this pressure test.

#1) Why in the world would he add an additional chemical to my eye when he could have simply used a Tonopin, as I have always had normal eye pressure?
#2) I have read that small amounts of eye drops can partially drain into the corner of your eye and down into your throat.  Since I never had that additional drop, I assumed the connection with the throat closing problem of which could have been there earlier in the day but became worsened while I was laying down in the prone position ?

[John C Hagan III, MD, FACS, FAAO]

FIrst of all its very important for a patient to have confidence and rapport with his/her physician and I suggest you make a list of your questions and ask the physician. The extra drop is no big deal and was done for your safety. Your surgeon wanted to be sure the pressure in your eye was not high before starting your surgery. Its SOP and done sometimes in the pre op area and some times in the OR.  The blue light pressure test (using Goldman technology) is more accurate than the tonopen. Dilation often raise the pressure in the eye so its standard operating procedure. We do it.

2. Yes with a normal tear duct small amounts of the drops likely did run down your tear duct and into the back of your throat. However: if it did you nornally "taste" them right away. If they were going to cause a problem it would usually occur immediately to within 2-3 hrs of the surgery.

I have made the assumption you were done under local anesthesia (not put to sleep for general anesthesia). If it was general anesthesia then it is a common problem and easily explained due to a tube being put in your trachea (intubation) to breath for you while asleep.

Again ask your surgeon; clear the air; if the surgery went off smooth you are a lucky person.

JCH MD

[Luvtoski]

Just wanted to thank you again for your response.  The words "thank you" are overused but just know that us forum questioners consider your opinions invaluable.

Also, these drops were not for Cataract Surgery, as I haven't had that yet.  They were just for my evaluative appointment with the Cataract Surgeon.

Does that change any of your "standard operating procedure" answers?
And just wondering why the Tech would dilate the eyes first before they did the Pressure test, if the dilation drops increase the pressure?  

[John C Hagan III, MD, FACS, FAAO]

You're welcome. There are a number of possible explanations. Since you are going to be dilated for cataract surgery they may have wanted to know if that would raise your pressure. Start establishing a good rapport with your surgeon. Make a list of questions and ask him/her.  Also call the office and let them know your post office experience.

JCH MD

[Luvtoski]

Dear John,
I don't want to push my luck because I know you cannot keep answering questions, so I won't expect an answer here.

I have been giving a great deal of thought as to how to establish a good rapport with my surgeon, and other Doctors that I have appointments with.  The appointments feel so rushed, and I understand their busy schedules.  Ergo, I try to ask my questions as quickly as possible and as friendly as possible without stepping on their toes.  

What is it that you Specialists look for in a "good patient"  ?  They say they like a well informed / educated patient but does our questions come off as doubting their skills ?  Guess everyone is different, but is there any general tips you can give us patients from an "insiders" stand point ?

[John C Hagan III, MD, FACS, FAAO]

I think every patient, every physician and every interaction is different. Patients might click with some physicians and not others. Personally I don't have any problem with informed patients that ask good questions. I've always used consultants and second opinions freely and always try to get one if I sense a need (for me or for the patient).

Also given that there are huge numbers of patients to care for with the baby boomers getting older and the looming ACA law physicians simply cannot spend the amount of time per encounter that we have in the past.

Another very effective way is to call the office ask to speak to the doctor's nurse, give the nurse the questions, let her check with the doctor between patients and call you back.

Last comment on this string.
JCH MD