eyedrop rebound?

I have never reacted to eye dilation drops until recently.  Last year I was dilated numerous times with cataract surgery associations.  This year I had a right eye vitrectomy and more associated dilations.  The last few times, my eye was ultrasensitive as the drops wore off.  Today I had my one month post-surgery checkup and dilation.  No unusual side effects occurred until about 4 hours later, as the drops wore off.  I don't know what drops were used, but the eye tech said there were probably two.  The short term effects might be a clue as to the type of drop, as usually they last longer. I was doing fine until the 4 hr. mark when quite suddenly, I got a series of severe eye pains and extreme light sensitivity. Every time the eye tried to accommodate to even mild light, I got sharp pains in what felt like the iris muscles as they tried to unlock.  It was like they couldn't stretch out. There was also some residual burning and irritation, from the trauma, I think. I had to take a double dose of acetaminophen to be able to tolerate it. The eye became extremely red.  I used some Murine and it did soothe it and help the appearance. **I keep Murine around, but almost never use it.  Since the acetaminophen has worn off, the eye has stayed mostly better, although still somewhat bloodshot. I have Harlequin Syndrome (adult), probably from an upper spine lesion and when I exercise, the LEFT side of my face flushes and left head sweats excessively. My info is that the RIGHT side is the one actually compromised.  Would a peculiar muscular hyper- or hypo-reaction on the right side cause the right iris to not be able to recover well from temporary drug paralysis?   I also have a history of exaggerated rebound reactions to certain drugs and definite sensitivity to narcotics and opioids.  Any ideas?  I REALLY don't want to go through this again!  Thanks.

[Sandra M Brown, MD]

It sounds like you were having "accommodative spasm".  This can occur when the eye is trying to focus up close but is struggling to do so because the eye drops have -partly- worn off. so the internal iris focusing muscle is working 'sort of' and basically cramping up.  I think this may partly be due to how many times you have been dilated.  There are several different accommodation-blocking dilating eye drops - tropicamide, cyclopentolate, hycosamine, scopolamine, atropine.  Ask to know specifically what was used, maybe you can figure out that it is one drop over the other that causes these symptoms.  Also, an obvious fix is to not try to read the rest of the day.  Or, if only one eye was dilated, use a pirate patch on that eye for the rest of the day.