Eye problem - pupil enlarging

My daughter is 25 and works as an RPN in a Senior's home.  For the past 2 years her pupil will periodically enlarge - can happen to either eyes for no apparent reason.  This causes major headaches.  Then it returns to normal.  Can last from an hour or hours.  She went for a dye test and also had an MRI done and it shows an enlarged (can't remember the name) behind her head.  One doctor thinks it's the medication she breaks down for patients that get in her eyes.  She says sometimes she doesn't give medication and this still happens.  What should she do?

[Michael J Kutryb, MD]

Your descriptions still leaves me a  bit confused.  Are you saying she is getting medication in her eyes by mistake.  If that is the case, then that can easily be solved by changes in her work duties.  Otherwise - it important for her to be seen by an OPHTHALMOLOGIST right away the next time it happens.  This could represent some type of complicated migraine, or other neurologic disorder or even an attack of glaucoma.    If she has already sees an ophthalmologist, she may need to see a neuro-ophthalmologist.  She really needs to be seen while it is happening so the cause can be determined.  A brain MRI would be a good idea (already done, you said.)  Perhaps an MRA of the brain as well would be a good idea to rule out a vascular anomaly, and neuro-ophthalmology evaluation.

Michael Kutryb, MD