Paxil is well known to cause mydriasis or large pupils in 0.1 to 1% of patients on the medication. One potential danger of drug-induced mydriasis is the exacerbation of acute angle glaucoma in patients over 50 years old. However, in case reports from the literature the mydriasis should resolve with discontinuation of the drug and at 2 months, the medication should already be out of your system. Before committing to a diagnosis of autonomic dysfunction which usually presents with other signs and symptoms such as abnormal sweating patterns, bowel and bladder irregularities, blood pressure problems (both high and low) and tearing and salivary gland abnormalities among others, I would start with an ophthalmologist (not optometrist) and have your eyes formally examined, especially if vision has been affected. If your eye exam is normal with intact pupillary reactions to the eye doc's tests then that should be reassuring. If not then there are many syndromes that can potentially cause pupillary abnormalities in isolation (without any other disease process) and as part of a larger syndrome. It is quite possible that this has nothing to do with the paxil and was just coincidentally noticed on its discontinuation/ If you have decreased joint reflexes, then you could have what;s called Adie's pupils due to dysruption of ciliary muscle function which is found in normal individuals, usually young women.
Again, the differential diagnosis is exhausting for both primary and secondary causes of pupillary dysfunction including trauma, infection, ischemia, drugs, congenital and neurological syndromes. See an eye doctor and go from there. Good luck.
