recurrent, spontaneous mydriasis (had previous eye surgery)

Hello,

back in January I had a 360 degree scleral buckle put in my left eye following a macula off retinal detachment, and cryopexy to treat retinal holes in both left and right eyes. Following the surgery my left pupil has remained permanently dilated but the right had been functioning normally. The vision out of the left eye is distorted in general, and blurred for close activities such as reading, so I rely a lot on my right eye.

I have some exams approaching for which I need to do a large amount of reading, and after a day and a half of this the vision in my right eye became so blurry that it was impossible to read anything at all (but my distance vision seemed unaffected). It turned out that this pupil too was dilated. I was given 2% pilocarpine drops which brought the pupil back to normal within a few days. However, the same thing happened again two days ago. In both instances, the extreme blurriness has diminished somewhat before the pupil returns to normal size. At the time of writing, the pupil is dilated but I am able to read (with some strain).

Pressure in my eyes is normal and both retinas are attached.

I am waiting for a referral to a neuro-ophthalmologist but this will take several weeks, and in the meantime I'd be so grateful and interested to hear if anyone else has experienced something similar, or has an idea of the cause (and cure). Given the poor vision in my left eye, this has been quite a debilitating development.

Thank you very much for reading.

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

You don't mention your age. If you are late 30's or early 40's this could be a common sign of "middle age eyes" which is called "presbyopia". If you are younger you might have latent uncorrecte hyperopia or a muscle problem called convergence insufficiency.

Keep your appointment with the neuroophthalmologist and get yourself a pair of inexpensive over the counter +1.00 reading glasses and see if that helps you with your studying.

JCH MD

[Alleaffar]

Dr Hagan,

thank you very much for your reply and suggestions. I have reading glasses which I use to help with studying, and they do improve my vision for that but haven't been enough during these two episodes.

Sorry for not mentioning my age; I am female and in my early twenties.

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

You may have latent hyperopia. When you see the ophthalmologist ask for a "push plus, fogging technique pre dilated refraction and a post dilated cycloplegic refraction". That is a way of telling if you are farsighted and how much of the correction you might "accept" when your eyes are not dilated.

You can print this out and take in to show the techs and the ophthalmologist.

John C. Hagan III MD, FACS, FAAO

[Alleaffar]

Thanks very much indeed for the detailed advice, Dr Hagan. I shall do as you suggest. I am quite severely myopic - is it possible to have latent hyperopia at the same time?

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

No but it is possible you've over-correct. Since you're myopic you do not need a push plus fogging exam, what you need is a "post-cycloplegic refraction". Tell them you wish to be sure you're not "over-minused"

JCH MD

[Alleaffar]

Many thanks again, Dr Hagan. I shall ask about the post-cycloplegic refraction. Do you suggest that being "over-minused' or having 'convergence insufficiency' might account for the right eye dilating?

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

No it would not account for dilating te pupil. A scleral buckle can damage the pupil and make the pupil not match the unoperated pupil.

JCH MD

[Alleaffar]

Ok, thank you for the information, Dr Hagan. The left pupil is permanently dilated following scleral buckle, but I was wondering about the right, unoperated pupil which has become dilated twice over the last few weeks, with each episode lasting a few days, during which time the pupil remains dilated at all times.

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

In that case I have no explanation for the "virgin" eye dilating and staying dilated. Nor would this be related to convergence insufficiency or being over minused.

Your best bet to tie up all these loose ends in the fewest numbers possible would be to see a neuroophthalmologist. If you experience another episode take some pictures of the pupil dilated (no flash or red eye flash). Also take in to the NeuroOph some good facial pictures of you as a child or teenage that show the size of your pupils.

JCH MD

[Alleaffar]

Thank you for the tips. I hope I won't have to wait too much longer for my appointment with the neuro-ophthalmologist and when I go I'll take pictures as you suggest.

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

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