dilating eyes

I am a PA in remote Alaska.  A 12 year old patient and her mother come in today stating the patient has had several episodes, lasting minutes up to 2 hours, when her eyes are very dilated.  She has also been having a dry, burning sensation and rubs eyes vigorously.  Mother has compared her eyes to the patient and they are very different dilation in similar lighting.  Child denies drug, alcohol, caffeine.  Vision is unchanged.  There is no eye care in this community the closest is 200 miles away.  Do I need to be concerned about a systemic or significant eye process?  I have given her Patanol for the topical symptoms.  We do not have a Tonopen or similar item for pressure testing.  Thanks for your help.      

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

There are generalizations. The pupils are much bigger in adolescence that any other time of life. So would expect her pupils to be bigger than yours or moms. If pupils are merely "Big" but equal and react to light and accommodation (focusing), and they are aligned straight (no double vision), and no drooping of eyelid (ptosis) and vision is equal generally there's nothing extremely serious going on.  Please note that Patanol, Visine and other allergy drops and eye whiteners can dilate some pupils especially if the person wears contacts or had an irritated cornea. Glaucoma is not at all likely. In addition to patanol you can try artifical tears, and warm compresses. As it gets colder and the air dryer be sure to keep the home humidified.

I spent two years in the US Air Force stationed in North Dakota and the dry air was very tough on the eyes.

JCH III MD  Eye Physician & Surgeon