Irregular dilated pupil following cataract surgery

[Audrene]

I had cataract surgery about 5 weeks ago.  My pupil has continued to be dilated in an irregular shape since that time.  I am using 1% Pilocarpine Hydrochloride drops 3x/day.  It is normal when I wake after putting the drops in before bedtime, but begins to enlarge shortly after waking.  It remains down for about 4 hours following he use of the drops.  Any suggestions as to cause or treatment?

[mike230]

FIrst of all, what lens did you have implanted?  If you have read my post, I share the same experience as you do.  Here is the story.  I had thought the damage was from both the cataract surgery, vitrectomy and retinal surgery I had, all in 4 wks. time.

The cataract surgeon has this slit lamp with the ability to take enlarged photos of the eye on the computer and the picture revealed that I have an adhesion between the back of my pupil and front of the capsular bag, where the IOL is implanted.  The adhesion is from the 10:00 to 1:30 position.

This condition is very treatable via 2 methods; the conservative approach which I am currently undergoing is pharmaceutically 1% pred forte drops every 2 hrs. while awake and the cyclopentolate 2% which diolates the pupil which the goal is to work the pupil back and forth to break up the adhesions.

The last resort which is the quickest method is via minor surgery, visco dissection in which a gel is injected where the adhesion is located to break up that tissue.  

I am sure things you see, especially at distance is kind of distorted under certain lighting conditions and sharper at other lighting conditions.  Hope this info helps
Good Luck,
Mike

[Flavius G Pernoud III, MD]

Sometimes the pupillary sphincter is affected by the instrument that is pulverizing the cataract. If so, the pupil will not constrict as completely as normal. I would continue the Pilo for a while. The pupil may maintain its smaller shape. It is unlikely that the pupil shape will have much, if any, affect on your vision.