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Traumatic Mydriasis, need help

Hi everyone. I have what seems to be a traumatic mydriasis from blunt trauma to my right eye that happened back in the middle of December.

My history:
Middle of December I took a slapshot to the eye from a rigid PVC hockey ball (wasn't wearing a cage). I immediately lost vision in my right eye. I was rushed to the hospital and determined to have a hyphema. The only thing I could see was light. The next day, the doctors could not get an accurate pressure reading on my eye so they decided to perform an "exploration of the eye" surgery, and found out that I had no tears or ruptures. The day following the surgery, and this is a big part, I was checked out by the doctor and he said when he shined the light into my eyes, my pupil was reacting, so that was a great sign that my nerve was working. I was given Atropine to take 2x daily and Prodnolisone to take 4x daily. I am 25 years old, so you can gauge my healing capacity.

Since then, I was on bedrest for about 2 weeks, staying on the atropine during this time. I was seeing an opthalmologist every few days. The hyphema eventually reabsorbed and I regained vision in my eye. I d/c'd the atropine after 2 weeks of being on it, but stayed on prodnolisone for about another 2 weeks thereafter. About a month after the initial hit, now middle of December, I still had a mydriasis, probably around 8mm when compared to the chart. Bad photophobia, poor visual acuity, everything. I was prescribed Pilocarpine 1% to take 4x daily. Within the first dose of this, my pupil had constricted and I could see much more comfortably. I stayed on this for a week and upon dc'ing the pilocarpine, my pupil had gone back to full size within about 36 hours. I have been off all medication now since that time, seeing my doctor here in a week.

During the course, the doctors all thought I was still under the effects of Atropine, since there did not appear to be any tears in the iris muscle that were noticeable, and that was the best explanation for my very dilated pupil. Now that my entire history has been explained, is it POSSIBLE that since my pupil was reacting to light just 2 days after the surgery, and now doesn't react at all, that the atropine dilated the pupil beyond its normal range of travel and tore a muscle in the iris somewhere? I just don't understand how it was reacting to light initially after the trauma, but now is so unreactive and open. This has been an emotionally taxing ordeal and I'd like to understand where I go from here, or if the atropine may have caused me this permanent state of discomfort with my eye.

Thanks to anyone that can offer assistance, but if not, I hope any searchers with similar issues may be able to benefit from this post.
304 Responses
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177275 tn?1511755244
It sounds like you and your ophthalmologist have a plan. These cases are so individualized that I cannot cite any useful experience. Hope it works. JCH MD
Helpful - 1
233488 tn?1310693103
MEDICAL PROFESSIONAL
THIS DISCUSSION IS TOO LONG AND I WILL NOT BE RESPONDING TO MORE POSTS HERE. PLEASE START A NEW QUESTION IF YOU HAVE THIS PROBLEM.   JHAGAN MD
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Avatar universal
Hi everyone,

Apologies for reviving this long inactive thread, but having been diagnosed with traumatic mydriasis after traumatic hyphema (metal carabiner shot into eye from bungee cord) 2 weeks ago, this thread has been an amazing repository of information and experience.

A huge thank you to Waterwings; nearly two decades later and your thread is still helping people, including myself. And I'm certain I won't be the last.
As well as to Dr. Hagan. Thank you for sharing your professional insight over these years.

My optho - as helpful as he has tried to be - has been very vague on details of the condition and what to do. I suspect he is not entirely sure himself. I'm just 2 weeks into this journey that many of you have been walking for years, but I already feel knowledgeable on what to monitor and what questions to ask.

So thank you again everyone!! I will be updating the thread if anything in my case that hasn't been already covered here comes up and try to give back.
Helpful - 0
177275 tn?1511755244
This thread is too long and hard to find new postings. If someone had new problem don’t post here.  
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Avatar universal
Hey everyone I'm just checking in after a few years.  I'm sorry to hear about everyone's recent injuries but please remember, some of us that were given almost no chance of improvement have improved GREATLY.  It will take time, rest, and patience.  But stay positive.  :)  Life is not over and this will pass.
Helpful - 0
Avatar universal
I have a nerf gun injury, traumatic myadriasis, 6 weeks ago. Pupil still about 30% wider than the other. Wondering about trying pilocarpine to see if it can contract- seems a bit like it is atrophying at the moment because never contracts to its smallest size.
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2 Comments
Pilocarpine is NOT a treatment for 6 week injury. It increases the risk of retinal detachment and traumatic iritis.
OK. Do you think exercises are worth while? Either light/dark or straining to get focus? If I cover my good eye and practice on the bad one, my reading ability improves slightly but it hurts in the eye after a while.
Avatar universal
I have felt a noticeable improvement since the weekend
The eye feels a little sensitive,  and there is a weak, numb, or swollen type feeling above the eye/upper eyelid
Possible pressure and numbness It is hard to describe but still not feeling 100%
Also dealing with some depression trying to stay positive I keep reliving the experience
I am thinking it is good to go thru it while young maybe it could have happen in the future
I was so close to leaving the country,  now I have been home with parents not blaming the U.S. but I was used to a different culture overseas and coming back I was in a depressed place. I have to work on my attitude and not let things bother me . Take care of yourselves love one another protect yourself from violence ..

I am trying to grow from this  now I am not constantly reliving the experience just hoping that healing will continue past these 5 1/2 weeks

When I faced injury in the past the 6 week mark was the hardest, I believe I have already gone through the hardest now

Psychologically I miss my loved ones I've cast some aside feeling ashamed/weak

My heart hurts
Helpful - 0
1 Comments
Avatar universal
After about 5 weeks it is healing okay more or less. Just concerned with strange feelings and light pain. Almost like a TENSION in my body and the eye still feels a little weird. Head hurts as well. I heard facial fractures take 6 to 8 weeks to heal, at least the nerves

Could anyone shed some light on this

Mornings are the toughest, and mid-afternoon

Psychologically I feel a problem, like cannot focus my mind's eye, visualize, or dream of the future (although improving) can't visualize as well is there frontal lobe damage or just in my head

At some point I feel this will be more of a cosmetic issue which doesn't bother me

I having to put things in proper perspective altho difficult
Helpful - 0
Avatar universal
5 weeks ago I was punched in the left eye.  Have small tear(s) in iris sphincter muscle. In sunlight it constricts almost to not al size. Problem is dealing with pain and strange sensations throughout face and body. Was wondering if these feelings will subside. Also experiencing post traumatic stress-like symptoms. I have been diagnosed with anxiety disorder, depression and schizophrenia. Also not the first time being attacked. I am feeling suicidal.
Helpful - 0
4 Comments
Nose was fractured as was bones around eye.  I was under influence of cannabis when struck by fist.
Hello, we are sorry you are going through this very difficult time.  We have contacted you privately so please check your email and inbox on your medhelp home page.  Always remember that you can call 911 if you are contemplating self harm or a suicide pretention hotline such as 1-800-273-TALK (8255).  We wish you the very best.
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Avatar universal
Hi Dr John,

Firstly, this website and the threads have been so useful to me after having an eye injury a couple of months ago - thank you for sharing your expertise! I have a couple of questions in addition to the ones which others have asked.

I got hit during sports about 9 weeks ago which resulted in mydriasis and a scar on the lens of my eye. Initially there wasn't much movement in the pupil & it was a bit misshapen, however over the past 9 weeks the shape has improved (it is probably as circular as the good eye now, although much larger) and in daylight/direct artificial light it constricts a lot (not as small as the good eye but not noticeably different). The pupil also constricts quite well when focusing on objects close up.

Functionally the eye seems to be okay (other than screens looking blurry), however I've got very light colored irises and would really like it if the pupils would return to normal for cosmetic reasons.

My question is why does the pupil constrict quite well with light and focusing but doesn't constrict in response to emotional stimulation (for example boredom etc). I've found people looking at my strangely when I'm talking to them - it seems my good pupil is constricting/dilating irrespective of whether there is a change in light conditions whereas the injured pupil only responds to light and intentional focusing (rather than social/emotional reasons).

I was just wondering if this is to do with the intensity of the stimulation (i.e. light provides more stimulation than emotional changes) or whether this is to do with damage to the nerves that would provide the emotional information.

I know this is a pretty involved question about something very complex and delicate so it's completely understandable if there's no clear answer! If anyone has experience of a similar thing (or people who have recovered all of the pupils functioning, including the emotional/social response) then it would be interesting to hear from you.

Thank you for your time reading this and good luck to everyone else with mydriasis (I've been taking lots of supplements and eating healthy as was recommended on here).

Thank you,
Helpful - 0
1 Comments
First of all the most important this is whether there is any permanent damage to your eye.  A "scar on the lens of the eye" would be called a traumatic cataract.  You are also at higher than normal risk of retinal detachment and traumatic glaucoma.  You need to have your eye checked by a retina specialist to be sure you do not have breaks or tears in the retina or a problem called 'retinal dialysis"    You also need an ophthalmologist to do a test called 'gonioscopy' to see if you have 'angle recession" if so you have a significant risk of traumatic glaucoma and need baseline tests such as visual field, corneal thickness and maculalr and nerve fiber layer OCT.

The young iris has small movements that are unrelated to light exposure or focus to see at near. It's called 'hippus"   Likely the injured no longer does that and that's why it looks static compared to the uninjured eye. no way to fix that.  your pupil may continue to improve. By 6 months most people are at there final result although rarely i have seen improvement for up to a year.   Doesn't sound like you will need colored contact lens or drops to help make the pupil smaller.   Don't forget the other things that should be tested.
Avatar universal
Hello Dr. John and Everyone

May 1, 2017
I hit my eye with a baseball.

Traumatic cataracts are said to be very small (which is later said to be fine enough to age a little earlier than normal eyes)

And the traumatic pupil mydriasis, the iris has been torn off a little.

The first one or two months do not move at all, and then gradually diminish in response to light.

About five to six months later
It is fine in daylight and very bright, but it is still large in dark places.

Even after 5 to 6 months of pupil
Could it be smaller and move?


(I was originally a diopter - 8 high myopia and received vision correction four years ago)
Helpful - 0
1 Comments
It could be at 6 months most cases are stable.  Ask your ophthalmologist about a trial of Alphagan-P which helps the pupil stay small in dim/dark light
Avatar universal
Hi All,

I have traumatic mydriasis (1.5 months) after a football mishap and have been looking for solutions.

Would contact lenses with an occluded pupil work by reducing the amount of light entering my eyes?

Cheers,
Helpful - 0
3 Comments
Yes if the diameter of your damaged pupil is larger than the diameter of the pupil on a color contact lens. Also ask your eye MD ophthalmologist to try Alphagan-P eye drops.  Some improvement often occurs for 6-9 months
Thanks John, I'll that note of that.
Best of luck and remember to protect both eyes from another injury
Avatar universal
after a long time... I'm here to provide some hope to those who're recently facing this injury... after almost two years since my injury, it was improving time after time till the current state which is: I don't need glasses nor drops anymore. Sunglasses are optional now. and the vision is about 99% better. Sometimes seems it's better than before. I'd say that I'm 99.9% recovered. Regarding the pupil.. well, it's still bigger than the other one but is impossible to note the difference without pay a really attention over it.

Keep your hope. This terrible injury will improve with time.
Helpful - 0
1 Comments
Thanks for the follow up. PROTECT YOUR EYES FROM ANOTHER INJURY. Just saying.
Avatar universal
Hi Dr Hagan & Everyone,

I was hit in the eye 2 weeks ago and since then I have traumatic mydriasis. The pupil reacts to light and I feel it's a little better than a week ago, it's around 4 mm.

In the last visit to the doctor he told me he saw a little tear in the sphincter.

Is there still a chance that the pupil will go back tot normal even with the small tear in the sphincter?

Another problem I have is the blurred vision. I saw that reading glasses can help while working with computers, is there something that can help long distance focus?
Do you recommened the use of glasses for focusing?

Ben
Helpful - 0
1 Comments
First be sure you are under the care of an Eye MD ophthalmologist. Injuries such as these can be associated with problems elsewhere such as retina tears, retinal detachments, inflammation, glaucoma and traumatic cataracts.  Usually this is treated with steroid drops for the common association of traumatic iritis. Also if you are using a red topped bottle that dilates and rests the pupil and will keep the pupil bigger than after you stop it.  Sometimes the pupil returns to normal sometimes not. No way to tell yet.  Since your other eye was not injured most people do not need to use reading glasses.  Distance glasses are prescription and too early to see if you need one.
Avatar universal
Dr Hagan, is it possible for an aphakic to develop pco or capsule opacification? Reason I ask is I am trying to pinpoint my glare issues and slightly hazy vision to pco or traumatic mydriasis. Thanks
Helpful - 0
3 Comments
Yes it is possible if the posterior capsule was left in the eye or if a problem called Soemmering's Ring develops
thank you Dr Hagen, i have read online that younger patients are more suspect to pco? Is 34 considered "young enough" for pco 5 months into being aphakic ? can this easily be diagnosed or are special tests needed?
Yes at 34 PCO often develop quickly. Easy Dx with dilated pupil and biomicroscope (slit lamp exam)
177275 tn?1511755244
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Helpful - 0
Avatar universal
yep, it´s a little red. Okay then, thank you! ;-)
Helpful - 0
177275 tn?1511755244
Redness is not a consistent part of dilated pupil syndrome. Since its only a little red I would suggest not doing anything except perhaps using an artificial tear. Whitening eye drops like Visine and Murine are not good for long term repeated use.
Helpful - 0
Avatar universal
Hi John, since I got mydriasis, even using sunglasses, my injuried eye is a little bit red (let´s say it´s a eye: , the "-" chars are constantly red) and I noticed when I traveled during the night, driving for 5 hours, that it becomes too much red.

well, I´m sure it´s a result of mydriasis, but, what you think about it? there is a way to handle it ?

thanks again!
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177275 tn?1511755244
best of luck
Helpful - 0
177275 tn?1511755244
No I don't do that type of surgery and its not necessary to travel so far as there are many fine ophthalmologists in Florida.  Bascom Palmer Eye Institute at U of Miami is among the best in the world.

JCH MD
Helpful - 0
1 Comments
Thank you
177275 tn?1511755244
Depending on the status of your eye and your injury it may be very difficult. Plus if the pupil is made smaller with a "purse string" incision it will not dilate and it will be hard for the doctors to see and treat the back of your eye. You need to discuss with your retina surgeon and also get several opinions from cataract surgeons.

JCHMD
Helpful - 0
1 Comments
Thank you for the quick response, the injury happened on 12/31/2015 and as of yet I have not had high eye pressure. When the time comes is it possible to have a second opinion by you? I live in Florida but am willing to travel. Thanks
Avatar universal
John,
as i had a ruptured globe due to a metal wire penetrating my eye which left me aphakic, right now i am recovering from my second surgery where the doctors removed the silicone oil. I do not know the exact size of my pupil but i do know that I can not tolerate bright lights. my opthomogist has suggested that if my vision improves with a contact lens that I may not need any more surgeries but my concern is the possibility that i may have Mydriasis. i would prefer a permanent solution like and IOL, how complicated is to suture my iris if my doctor would perform the IOL surgery.

thanks
Helpful - 0
177275 tn?1511755244
No that is not a side effect of pred forte.  And is related to your injury.  Know that after a hyphema you are at increased risk of glaucoma, cataract, retinal detachment.

JCH MD
Helpful - 0
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