Long-term mydriasis/dilated pupil following scleral buckle

[Alleaffar]

Hi there, I'd be very grateful if anyone had any light to shed on my situation: just over three months ago, I underwent scleral buckle for a large retinal tearing and detachment in my left eye. I was taking atropine four times per day for the first two weeks, then twice a week for another two weeks, after which I stopped the atropine completely, one month after the surgery and over two months ago. Shortly after taking the atropine, the pupil got slightly smaller, but since then it hasn't reduced further in size, and remains dilated all the time. Along with that I get the obvious related complications of light sensitivity, inability to read. The eye also stings quite a lot but I imagine that could also be a usual after-effect of the surgery.

I am feeling a little confused as one doctor I saw three weeks after stopping the atropine said it would definitely not be the atropine after three weeks, and I should come back a month later and perhaps have an operation to loosen or remove the buckle if the symptom persisted; when I did return a month later, the doctor I saw (different from the first) said the atropine was the cause of the pupil being dilated. I believe she checked the pressure in the eye and thought that seemed alright. All other sources seem to suggest that atropine always wears off after one week, or two at most, even in light eyes which are apparently more sensitive to it (my eyes are greenish blue).

Has anyone else had a similar experience with atropine/scleral buckle surgery? I would love to know other opinions on this, and sorry if anyone else has already started a thread about it; I have been looking and couldn't find anything directly relevant. Also, are there any risks associated with having a permanently dilated pupil?

Many thanks, and I hope you are all having a good day.

[JohnHaganMD]

No not at all likely. Sorry

[ICUnot]

I was taking 200 mg Plaquenil for Sjogrens Syndrome & developed a retinal tear that turned into a giant retinal detachment.  I was informed that in a small number of people Plaqenil can effect the retina  I have stopped the Plaquenil but had to have a vitrectomy and now my pupil will not dilate causing extreme pain etc.  What are you thoughts about Plaquenil and avoiding its use if you have a lattice deterioration?

[ICUnot]

I was taking 200 mg Plaquenil for Sjogrens Syndrome & developed a retinal tear that turned into a giant retinal detachment.  I was informed that in a small number of people Plaqenil can effect the retina  I have stopped the Plaquenil but had to have a vitrectomy and now my pupil will not dilate causing extreme pain etc.  What are you thoughts about Plaquenil and avoiding its use if you have a lattice deterioration?

[49Carol]

Had vitrectomy last week for damage from vitreomacular traction.  Used atropine drops for three days after.  Now I am three days off atropine and my pupil is dialted to at least 1/2 of the iris.  Scary.  I know I am early in this process, but am so hoping that the pupil goes back to normal.  I know that my vision will not be 100% because of the macular hole, but I didn't anticipate the pupil problem too. Am hoping that what I am seeing on line are equates to very few people with an ongoing problem with the dilation.

[Juby1888]

I have the same glare issue after RD double vitrectomy with nitrous oxide bubble and 360 buckle over 6 months ago.  4.5mm pupil, sluggish response.  The glare didn't appear until after the subsequent IOL implant 3 months ago.  Problem is the glare makes it impossible to work with optometrist's eye charts to get an accurate optical lens scrip.  So, until the lazy, dilated pupil problem goes away, I can't read.  Complicating factor is my other eye is useless because I was born with ambliopia.  Even though the lazy eye is corrected to 20 20, the brain rejects it.  Plus, the RD eye is still having some inflamed macular issues.  The glare combined with the wavy macular interpretation of image compound the issue.  The wavy image is not bad and could be seen clearly without the glare.

So, is it possible that the buckle is compressing pupil control nerves.  If so, can it be removed since the retina has fully healed?  Or, any other suggestions would be appreciated.

Eye drops, still being instilled after 6 months are prednisilone acetate and Nevanac.

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

Good luck
JH MD

[Alleaffar]

Dear Dr Hagan,

thank you so very much indeed for your help. I am so sorry that I was unable to write before to thank you.

I hope everyone else finds something that helps for their problem.

[sb001]

Thank you for your suggested options - much appreciated!

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

My opinion is stated in previous replays. Note: Pilocarpine increases the risk of RD especially in stronger than 0.5%

JCH MD

[otacon]

İ do not use them at the same time. Dr used atropine while checking the back of the eye. İ used pilocarpin for testing only one time. My eye is sensitive to light also, but its initial state is bigger than mild dilated. İ want to get ypur opinion about this mid dilation. Thanks
..

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

DIscuss with your surgeon. You should not be using atropine and pilocarpine at the same time.

JCH MD

[otacon]

Hello,
İ have the same problem after facovitrectomy. My eye is still bigger than mid dilated. İ had the operation 40 days ago. İ did not use any dilating drops during healing period. When i use pilocarpino it gets smaller, when i use atropine it gets bigger. But after a few hours it returns to its mid dilated size. İt is resoective to light also,  in light conditions it gets a bir smaller and in dark it gets more larger. İ do not know what is happening in my eye. İ have lots of glare, blurry and i can not read. İ see the edges of my iol also.

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

Some improvement is often seen over a 6 month period, after that time not much. It depends a great deal on how dilated it is and how much problem you are having. These are some options:

1. Protect the eye from excess light-hat with brim, goggle-wrap around sunglasses, transition glasses that darken automatically.
2. Trial fitting of tinted contacts or a specialityh contact that has an artifical iris of a different color iris on it.
3. Trial of drops that can sometimes constrict the pupil: dilute pilocarpine and Alphagan P
4. "purse string suture to make pupil smaller" not a good option as the pupil doesn't move and it makes seeing into the eye difficult.
5. For a fully blown 6 mm pupil where nothing works Morcher company of Germany makes an intraocular artifical iris-pupil but it also does not constrict or get bigger.

JCH MD

[sb001]

My experience was the same as yours.  It has been 9 months since my scleral buckle surgery and my pupil is still dilated.  It is sensitive to light, but I also had my natural lens removed. My surgeon did not know why my pupil was enlarged and I assumed it was the atropine drops, so it is good to read Dr Hagan's comment.

[Alleaffar]

Thank you so much for your extremely helpful reply, Dr Hagan. If you have time, could you tell me what the consequences are for me if I am one of the small number of patients whose pupil becomes dilated during the RD operation? It was indeed a 360 degree buckle. Is there any treatment, or is a further operation ever recommended? I am experiencing a considerable amount of pain and discomfort from the dilated pupil.

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

Atropine is not the cause. For sure.  Atropine can keep a blue iris dilated for several weeks while it wears off but it will not keep a healthy pupil dilated "for ever".

A dilated pupil is a not uncommon occurence after RD surgery especially if a 360 degree buckle is put around the eye. It cannot be avoided in a small number of patients.

JCH MD

[qbanole03]

Doctor,
any chance of the iris working again if the scleral buckle is removed?

[Alleaffar]

*Correction* Sorry, I meant to say I was taking atropine twice a DAY after the first two weeks, not twice a week!