One pupil dilating, but constricts in light

[TheJennster001]

I was diagnosed with Uveitis a couple of months ago in my right eye after my eye became very red and I had some signficant pain in my eye.  I have been taking prednisolone 1.0% for the past 2.5 months - they tried weaning me off once and the redness came back so they dialed it back up, and are now working to wean me off again.  About two weeks ago, I started noticing that my right pupil was bigger than my left most of the time - something I had not noticed previously.  When I look in the light, my right pupil will constrict down to the size of my left, but when I look out of the light, it goes back to being larger.  I saw my opthalmologist last week and he did a light test, and because my pupil is constricting, he said he'll just keep an eye on it at my future check ups.  However since seeing him, I've also started feeling a bit of pain in/around the right eye again (feels more towards the back), and it feels a bit heavy. I'm not sure if this is indicating the uveitis is returning due to decreasing the drops or if this might be related to the pupil. I see the opthalmologist again in a week and a half.  I've read that one dialated pupil that is "blown" or doesn't constrict can indicate an aneurysm, but since mine constricts, I'm not sure if I should be worried and request to see him sooner, or if waiting for my next check up will be fine and I'm worrying for nothing. Any thoughts?

[JohnHaganMD]

Yes please get in soon. Not good to get behind the treatment of inflammation in the eye (like treating forest fires).  I believe your uvieits warrants a work up.

JCH MD

[TheJennster001]

Thank you! I really appreciate this info.  I'd actually found the association between the pupil dilating in one eye and aneurysms through WebMD, but your post makes me feel better that it is an unlikely scenario.

I haven't used the dilating drops with the red top since the first week I was diagnosed in August, and I've only been taking the Prednisolone 1.0% since then, which is why the onset of the pupil dialiting has been so strange.  The uveitis has never gone away, just improved and then worsened, so sounds like it might be worsening again.  

The doctor has held off on a uveitis work up to date because it was only in one eye, but sounds like it's best to get back in to see him again soon.

Thanks again!

[JohnHaganMD]

First of all its extremely unlikely your pupil is due to an aneurysm or neurological problem. It is almost surely related to the uveitis.  The standard treatment of anterior uveitis (iritis) is to dilate the pupil with eye drops (they have a red top) and keep it dilated to prevent scarring of the pupil in the constricted position and steroid eye drops.  So if you used mydriatics (atropine, homatropine, cyclogel) with a red top that is probably the cause OR your doctor could have put long acting drops like atropine in the eye. You need to discuss.

Second if the pupil was dilated and you had a reoccurrence of uveitis you could have scar tissue (synechae) binding the iris to the lens.

Third if you are having persistent and recurrent iritis you should talk with your ophthalmologist about working with an internist or rheumatologist to do a "uveitis work up" to determine if you have any systemic disease such as rheumatoid arthritis, sarcoid, etc.

Suggest you read up on uveitis on Wikipedia, WebMD, emedicine or other reliable website.

JCH MD