dialated pupil

[PPanos6292]

About 4 weeks ago, I was shot in the eye by a crazy kid at work with an aerosoft gun. The pellet hit  the upper right side of my pupil on my left eye, my vision was blurred for about 3 days and it caused a corneal abrasion, the abrasion healed completely and my vision was back to normal in less than a week. The only problem now is that I still have a dialated pupil 4 weeks later, the dialated pupil is 4.5mm compared to 3mm on my other eye. I have no problem seeing close or far, and no problem with light. The dialated pupil reacts a bit slower to light. The pupil size returns to normal with both Pilocarpine 0.5% and Alphagan, it also appears normal for a while when I wake up in the morning. What kind of a recovery can I hope for? How long does it take? Do I at least have some hope?

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

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[Mack51265]

I am in the same situation as you are - see my post on 11/12 titled trauma.  My injury occurred on the evening of 11/04/07 - so I am not quite 4 weeks out yet.  Here lately - last week or so - it seems that the pupil is smaller in the morning when I wake up and then returns to the big size fairly quickly.  Only yesterday and today the pupil stayed small (still not as small as the other one) when I drove in bright sunlight.  My pupil also reacted completely to pilocarpine - I have not tried alphagan yet (I do have a sample bottle).  I am encouraged (unlike my doctors) that it will regain normal function - I can tell it is getting better slowly.  Keep praying!

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

I think the MRI will be normal. What he said is the rule, what I said is the exception. Hope for the exception.

JCH III MD

[PPanos6292]

At my doctors appointment today, I was told that my left eye is now as responsive to light as my right eye. ( this was not the case two weeks ago). He than went on to say that he does not feel there will be much more change as far as the pupil size is concerned, he said doctors will tell you that healing continues for three or six months, but this is only the exception and not the rule. He said, that he has had lots of experience with these cases and it is rare for someone to have any significant change after a month. I also told him that I was planning on taking an MRI (to see if it can show any kind of muscle or nerve damage) but, he said this would be a waste of time, because the MRI would not show anything. ( I had the MRI done anyway and am now waiting for the results) He than said I'm really sorry, this is as good as it gets, if you think I'm wrong "get a second opinion and prove me wrong". Do you think this guy was just having a bad day, or is there some truth to all this?

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

PPanos6292 the answer still hasn't changed. I have seen improvements for up to six months.

JCH III MD

[PPanos6292]

One of my doctors, just told me that since it has been a little over 4 weeks, that I should not expect major changes, because these changes usually take place the first couple of weeks. She said that even if doctors say up to six month's, those are rare cases. My other two doctors feel that there is still significant room for improvement and the chance is better than just rare. Is my first doctor being to pessimistic or am I being to optimistic? Do you think I should have seen more change take place by now?

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

Please re-read my first post. 6 months the answer hasn't changed. Yes I have seen cases like yours make a complete recovery. Good luck.

JCH III MD

[PPanos6292]

I'm sorry, I'm starting to feel like a pest. I have one more question, do you actually know of any actual cases similar to mine that have had a full or near full recovery? And again, If I were to see any changes even minor, how long would this take, is 4 weeks still to soon?

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

Yes, in cases where there is bleeding (hypema), inflammation (traumatic iritis), dilocated lens, vitreous bleeding, retinal detachment and tearing of the iris constrictor muscle the prognosis is poorer. If all else is okay then prognosis is better. Again only time will tell.

JCH III MD

[PPanos6292]

I am a counselor, the kid was 14 years old and a client, and yes the staff was negligent as well for letting him sneak this gun into the facility. My question is, if I were to see some changes even minor, how long would this take. My doctor seems to think that the pellet may have been to small to destroy the mucle and after examination both doctors tell me that the optical nerve appears to have no damage, they feel it may just be the nerve fibers. Does this give me a better prognosis? Is it still to early to start losing sleep over this?

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

Yes the fact that it is not completely paralysed and responds to pilo and alphagan are all good signs. Generally I tell my patients with this type of injury that at six months further improvement is unlikely. So keep your fingers crossed for another 5 months.

JCH III MD

PS you would have to be crazy to bring a realistic looking air-gun to work and both negligent and criminal to shoot someone with it.